Implementation of Point of Care Ultrasound in extended focused assessment with sonography for trauma at a rural hospital in Uganda

Abstract

ABSTRACTIntroductionFocused Assessment with Sonography for Trauma (FAST) is a rapid bedside ultrasound examination performed at presentation of a trauma patient whereas the extended FAST (eFAST) examines each hemithorax for the presence of free fluid and air. It is an ‘extension’ of the trauma clinical assessment process and aids rapid diagnosis with an aim of identifying free peritoneal fluid which allows for immediate transfer to theatre or further imaging. FAST can be performed by surgeons, emergency physicians, and paramedics as a screening test to detect post-traumatic pericardial effusion or hemoperitoneum, performed at presentation of a trauma patient.ObjectiveThe purpose of this study was to evaluate the feasibility of implementing a point of care ultrasound training in trauma for non-imaging health professionals and evaluate the ability of the trainees to apply the knowledge and skills gained to perform the ultrasound examination among trauma patients.MethodsIt was a prospective cohort study conducted at Kiwoko hospital, a rural based hospital in Uganda. The study involved developing a curriculum and training of clinicians in point of care ultrasound for trauma patients through didactic lectures and practical sessions as well as assessing them at baseline and thereafter further assessment at three months follow up.ResultsA total of 19 clinicians were initially enrolled however, 12 were evaluated at baseline and nine were followed up for three months. The median length of time in clinical practice of the clinicians in this study was 11(2-36) months. At baseline, majority of the clinicians correctly identified and named all the anatomical structures pertinent to images obtained in eFAST; sub-xiphoid view 7(58.3%), right upper quadrant view 5(41.7%), left upper quadrant view 6(50.0%), suprapubic view 7(58.3%), thoracic-pleural fluid view 7(58.3%), and thoracic-pneumothorax view 4(33.3%). At follow-up, the clinicians demonstrated acceptable competency in ultrasound technique when performing eFAST in most views assessed. However, compared to the baseline observation, a statistically significant decline (p=0.001) in image quality was noted in evaluation of organs in the left upper quadrant.ConclusionClinicians generally demonstrated acceptable competency in performing eFAST assessment in trauma patients. With more training, frequent hands-on practice, regulation and adequate supervision, clinicians can ably perform eFAST procedures to aid in management of trauma patients.