Research in global health: The Introduction of FAST in Uganda

1
Research in global healthThe Introduction of
FAST in Uganda

• Jennifer Y. Wang

2
Challenges in global health research

• Identifying mutual areas of research interest
• Resource building
• Training in research techniques (laboratory,
  epidemiology, and statistics)
• Determining feasibility and cost-effectiveness
• Using available technology for data
  transfer/sharing

3
Injury in Uganda

• Road traffic crashes top the list of injuries
• Result in 30 of casualty visits
• Injury prevention!!
• Improve patient management upon hospital arrival

4
Current Management

• Plain X-rays
• Peritoneal Aspiration
• Ultrasound by ultrasonographer (if available)
• Observation
• Exploratory laparotomy
• And nowFAST
• Focused Assessment with Sonography for Trauma
• Free fluid in pericardial, RUQ, LUQ, pelvis views

5
FAST study

• WHO Guidelines of Essential Trauma Care 2004
  ultrasound is desirable
• Identified in a April 2005 meeting to be area of
  interest for Ugandan surgeons
• Innovations Grant from UCSF Global Health
  Sciences
• Portable US machine
• donated by Sonosite

6
Study Aims

• Aim 1 To evaluate the feasibility of FAST
  training for surgeons at a major Ugandan trauma
  center.
• Aim 2 To compare the management and outcomes of
  Ugandan trauma patients before and after the use
  of FAST, and to assess its cost-effectiveness.

7
FAST course

• November 13-16, 2006
• 20 hours of training
• 19 participants plus ultrasonographer
• Daily lectures, practical sessions, and final
  practical exam

8

• Website created by the Mulago-UCSF Malaria
  collaboration

9
(No Transcript)
10
Ongoing work

• 1st 4 weeks of images
• In 13/23, instructors agreed with all 4 images
• In 10/23, instructors agreed with 3/4 images
• Surgeons continuing to acquire FAST images (need
  25 each)
• Data collection on trauma outcomes underway- 83
  subjects from Dec 1 to mid Jan.

11
Acknowledgements

• The UCSF team Dr. Peggy Knudson, P.I. Dr.
  Rochelle Dicker, Co-I Dr. Jeremy Durack,
  Radiology Resident Eric Chen, MS3 _at_ UC Davis
• Our colleagues at Mulago Dr. Jackie Mabweijano,
  Victor Angajoubi, Mr. Isaac Ezati, Geoff Lavoy