title: Integrating eFAST in the initial management of stable trauma patients: the end of plain film radiography.
abstract: BACKGROUND
  The initial management of a trauma patient is a critical and demanding period. The use of extended focused assessment sonography for trauma (eFAST) has become more prevalent in trauma rooms, raising questions about the real "added value" of chest X-rays (CXRs) and pelvic X-rays (PXR), particularly in haemodynamically stable trauma patients. The aim of this study was to evaluate the effectiveness of a management protocol integrating eFAST and excluding X-rays in stable trauma patients.
  
  
  METHODS
  This was a prospective, interventional, single-centre study including all primary blunt trauma patients admitted to the trauma bay with a suspicion of severe trauma. All patients underwent physical examination and eFAST (assessing abdomen, pelvis, pericardium and pleura) before a whole-body CT scan (WBCT). Patients fulfilling all stability criteria at any time in transit from the scene of the accident to the hospital were managed in the trauma bay without chest and PXR.
  
  
  RESULTS
  Amongst 430 patients, 148 fulfilled the stability criteria (stability criteria group) of which 122 (82 %) had no X-rays in the trauma bay. No diagnostic failure with an immediate clinical impact was identified in the stability criteria group (SC group). All cases of pneumothorax requiring chest drainage were identified by eFAST associated with a clinical examination before the WBCT scan in the SC group. The time spent in the trauma bay was significantly shorter for the SC group without X-rays compared to those who received any X-ray (25 [20; 35] vs. 38 [30; 60] min, respectively; p < 0.0001). An analysis of the cost and radiation exposure showed savings of 7000 Є and 100 mSv, respectively.
  
  
  CONCLUSIONS
  No unrecognized diagnostic with a clinical impact due to the lack of CXR and PXR during the initial management of stable trauma patients was observed. The eFAST associated with physical examination provided the information necessary to safely complete the WBCT scan. It allowed a sensible cost and radiation saving.
authors.affiliation: Anesthesiology and Critical Care Department, Service de Réanimation chirurgicale, AP-HP, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France. sophiehamada@hotmail.com.
authors.forename: Sophie Rym
authors.identifier: http://orcid.org/0000-0001-8405-5997
authors.initials: SR
authors.lastname: Hamada
authors.affiliation: Anesthesiology and Critical Care Department, AP-HP, Hôpital Pitié-Salpêtrière, Hôpitaux Universitaires Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Delhaye
authors.affiliation: Department of Anesthesiology and Critical Care, Lariboisière University Hospital, AP-HP, Paris, France.|ECSTRA Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Centre, UMR 1153, INSERM, Paris, France.|University of Paris VII Denis Diderot, Paris, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Kerever
authors.affiliation: Anesthesiology and Critical Care Department, Service de Réanimation chirurgicale, AP-HP, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.
authors.forename: Anatole
authors.initials: A
authors.lastname: Harrois
authors.affiliation: Anesthesiology and Critical Care Department, Service de Réanimation chirurgicale, AP-HP, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Duranteau
keywords: Diagnostic accuracy; Imaging; Resuscitation; Severe trauma; Stability; Ultrasound