Chest Abdominal-Focused Assessment Sonography for Trauma during the primary survey in the Emergency Department: the CA-FAST protocol.

PURPOSE: To evaluate the feasibility of a new protocol, Chest Abdominal-Focused Assessment Sonography for Trauma (CA-FAST), during the primary survey and to estimate its diagnostic accuracy when compared with thoracoabdominal computed tomography (CT) scan. METHODS: A prospective accuracy study was performed from November 2012 to November 2013 at the Emergency Department. Only adult trauma patients who underwent a CA-FAST examination prior to a thoracoabdominal CT scan were enrolled. In addition to standard patterns detected by Extended-FAST (E-FAST) such as pneumothorax (PTX), hemothorax (HTX), pericardial and intraabdominal effusion, CA-FAST protocol also included the research of lung contusions (LCs). RESULTS: Six hundred and one patients were enrolled. The mean time for protocol execution was 7 ± 3 min. Chest ultrasonography showed the following results (all p < 0.001): LCs sensitivity 59 %, specificity 98 %, positive predictive value (PPV) 92 %, negative predictive value (NPV) 86 %, accuracy 87 %; PTX sensitivity 84 %, specificity 98 %, PPV 93 %, NPV 95 %, accuracy 95 %; HTX sensitivity 82 %, specificity 97 %, PPV 87 %, NPV 95 %, accuracy 94 %. The standard 4-views FAST examination showed a diagnostic accuracy of 91 % with a sensitivity of 75 %, specificity of 96 %, PPV of 81 % and NPV of 94 %. CONCLUSION: According to our results CA-FAST protocol proved to be a rapid bedside method, with good accuracy and high NPV in detection of ultrasonographic patterns suggestive of serious injury in trauma patients; moreover, the additional research of LCs did not cause a delay in the diagnosis. Ultrasonography should be used as initial investigation during the primary survey, sending to further diagnostic studies (CT scan) only those patients not clearly classified.

A health assessment of high status Christian burials recovered from the Roman-Byzantine archeological site of Elaiussa Sebaste, Turkey.

The purpose of this study is to assess the state of health of 116 individuals whose remains were excavated from Byzantine period burials underneath the floor of an important Christian basilica from the site of Elaiussa Sebaste, Turkey. Elaiussa Sebaste was a Mediterranean coastal community, which began as a Roman town and continued as an early Christian Byzantine community until the end of the 7th century AD. The burials date from the middle of the 6th through the middle of the 7th centuries AD. We attempt to determine how high social status has influenced the type and frequency of skeletal lesions exhibited in this sample. All strata of this population show a number of chronic and acute health problems as indicated by skeletal lesions. Yet, only the frequency of degenerative joint disease (DJD) differs by sex, with males exhibiting a higher rate of DJD than females, p=0.09. There is no difference in the frequency of trauma among adult males and females. Non-specific skeletal lesions (cribra orbitalia, porotic hyperostosis, and periostitis) often associated with dietary and general stressors, but also with specific systemic diseases, are common in both sexes. The sub-adults primarily exhibit periostitis of the long bones and do not show skeletal lesions specific to malaria. It seems that high social ranking did not prevent serious ailments from affecting the health of individuals living in the Elaiussa Sebaste community.

Cranial trauma in iron age Samnite agriculturists, Alfedena, Italy: implications for biocultural and economic stress.

The Samnites are an Iron Age protohistoric people from the central region of Italy. The skeletal remains are from the Alfedena necropolis, 6th through 5th centuries B.C. Macchiarelli et al. (Antropologia Contemporanea 4 (1981) 239-243) were the first to report on cranial trauma for this population, presenting four cases with extreme injuries. We re-examined this well documented skeletal population for additional examples of trauma. Previously unexamined remains from Alfedena, excavated at the turn of the 20th century, are also included in our analysis (Mariani. 1901. "Aufidena", ricerche archeologiche e storiche del Sannio settentrionale. Roma: Acc Naz Dei Lincei). Of the 209 adult crania examined, 12.9% of them exhibited trauma. Analysis of location and frequency of cranial trauma revealed that cranial injuries to the head appear to originate from all directions. The high rate of cranial trauma underscores the violent circumstances experienced during the Iron Age protohistoric period of central Italy. Males are much more likely to exhibit cranial injury than females (P = 0.009). We conclude that the injuries received by Samnite male farmer-warriors occurred while defending pastoral-agricultural resources. Trauma rates are similar for some Iron Age populations and not for others. Behavior associated with violence during the Iron Age period can not be generalized for all populations found in Italy.