Surgeon-performed bedside organ assessment with sonography after trauma (BOAST): a pilot study from the WTA Multicenter Group.
BACKGROUND
Although nonoperative management of solid organ injuries is a well-accepted practice, a rapid method to assess the progression of the injury, the early development of organ-related complications, and the frequency with which follow-up computed tomography (CT) scans are needed has yet to be determined. The use of ultrasound in this setting may provide information that would improve the rate of organ salvage and decrease the patient's morbidity. The objectives of this study were to determine whether surgeons could successfully use a bedside organ assessment with sonography after trauma (BOAST) examination to: (1) detect a solid organ injury; and (2) assess for changes in the size of the organ injury, an increase or decrease in hemoperitoneum, and the development of organ-related complications.


METHODS
A prospective, multicenter study was conducted using BOAST to evaluate patients undergoing nonoperative management of their solid organ injuries. Patients had to have: (1) a Focused Assessment for Sonography of Trauma (FAST) examination on admission; (2) a solid organ injury documented by an admission abdominal CT scan; and (3) the criteria for nonoperative management. BOAST was performed within 24 hours of admission and every 3 to 4 days to evaluate for an increase or decrease in hemoperitoneum [Ultrasound (US) heme score: from 0 = none to 3 = large], change in injury size, and organ-specific complications. BOAST results were compared with the radiologists' interpretation of the initial and follow-up CT scans, and with patient outcomes.


RESULTS
During a 22 month period, 126 patients sustained 135 solid organ injuries, 46 (34.1%) of these were seen by BOAST (Error rate = 66%). Serial US heme scores = 0 (no hemoperitoneum) were observed in 56 of 126 patients who had a combination of multi-system injury and a dropping Hgb, indicating that there was no further bleeding from the injured organ(s). Surgeons detected 13 of the 15 complications that were confirmed later by conventional imaging.


CONCLUSIONS
(1) BOAST has limitations in identifying solid organ injuries, especially those that are lower grade; (2) the US heme score is a valuable adjunct to the clinical examination in following patients with high-grade solid organ injuries and a dropping hemoglobin; and (3) although uncommon, organ-related complications may be identified using BOAST.
Rozycki
Grace S
GS
Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA 30303, USA. grozyck@emory.edu
Knudson
M Margaret
MM
Shackford
Steven R
SR
Dicker
Rochelle
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006465:Hemoperitoneum / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D007223:Infant; D007668:Kidney / Q000000981:diagnostic imaging* / Q000293:injuries; D008099:Liver / Q000000981:diagnostic imaging* / Q000293:injuries; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D019095:Point-of-Care Systems; D011446:Prospective Studies; D011859:Radiography; D013154:Spleen / Q000000981:diagnostic imaging* / Q000293:injuries; D014463:Ultrasonography / Q000379:methods; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging*