Polytrauma as a Global Health Challenge Trauma is one of the leading causes of death and disability worldwide and continues to pose a major public health challenge despite substantial advances in emergency medicine, trauma systems and critical care. The World Health Organization estimates that nearly 4.4 million people die annually due to traumatic injuries, accounting for almost 8% of all global deaths. Beyond mortality, traumatic injuries are responsible for considerable long-term disability, loss of productivity and increasing healthcare expenditure, particularly among economically active populations (1,2). Polytrauma describes the presence of multiple severe traumatic injuries involving different anatomical regions or organ systems that require rapid multidisciplinary assessment because simultaneous injuries frequently complicate diagnosis and management. The burden of trauma extends well beyond mortality. According to the Global Burden of Disease Study 2019, injuries accounted for more than 250 million disability-adjusted life years (DALYs) worldwide and remain among the leading causes of premature mortality and disability, particularly in individuals aged 10–49 years (3). The impact is especially severe in low- and middle-income countries, where deficiencies in trauma systems, prehospital care and access to definitive treatment contribute to disproportionately high trauma-related mortality (5,6). India has experienced a steady rise in trauma-related morbidity and mortality, with road traffic accidents remaining the predominant mechanism of injury, followed by falls, industrial accidents, assaults and sports-related trauma. Trauma patients frequently present with blunt abdominal and thoracoabdominal injuries requiring prompt diagnosis and emergency surgical intervention. The increasing burden of trauma continues to place considerable pressure on emergency departments and tertiary care trauma centres (2,3). Timely diagnosis remains one of the most important determinants of survival in polytrauma. Uncontrolled haemorrhage is the leading preventable cause of early trauma-related death, making early recognition of life-threatening injuries and prompt haemorrhage control fundamental principles of modern trauma care (7,8). Consequently, rapid bedside diagnostic modalities that facilitate early clinical decision-making have become indispensable components of contemporary trauma management (9). Diagnostic Challenges in Polytrauma The initial assessment of polytrauma patients follows the principles of the Advanced Trauma Life Support (ATLS) protocol, which emphasizes rapid identification and treatment of immediately life-threatening conditions through the systematic Airway, Breathing, Circulation, Disability and Exposure (ABCDE) approach (9). Although this structured approach has significantly improved trauma care, accurate diagnosis during the early resuscitation phase remains challenging, particularly in patients with altered sensorium, multiple injuries, or ongoing haemorrhagic shock. The concept of the "Golden Hour" highlights the importance of prompt recognition and definitive management of life-threatening injuries, as delays in diagnosis are associated with increased morbidity and mortality (10). Uncontrolled haemorrhage remains the leading preventable cause of early trauma-related death and patients may initially appear haemodynamically stable despite substantial blood loss because of physiological compensatory mechanisms (7,8). Physical examination alone has limited sensitivity for detecting occult thoracic and abdominal injuries, especially in unconscious, intoxicated, mechanically ventilated, or multiply injured patients. Clinical findings may be masked by distracting injuries, obesity, or associated neurological impairment, potentially delaying definitive diagnosis and surgical intervention. These limitations have driven the development of rapid bedside imaging modalities that complement clinical assessment during the primary trauma survey (11). Evolution of Trauma Imaging The diagnostic approach to trauma has evolved considerably over the past four decades. Historically, trauma assessment relied primarily on clinical examination, plain radiography and Diagnostic Peritoneal Lavage (DPL) for detecting intra-abdominal haemorrhage. Although DPL demonstrated high sensitivity for haemoperitoneum, its invasive nature, inability to localize organ-specific injuries and limited utility in evaluating thoracic trauma gradually reduced its clinical use (12). The introduction of computed tomography (CT) revolutionized trauma imaging by providing detailed anatomical information and facilitating non-operative management of solid organ injuries. Contrast-enhanced CT remains the reference standard for evaluating haemodynamically stable trauma patients because of its high diagnostic accuracy. However, CT requires patient transfer from the resuscitation area, exposes patients to ionizing radiation and may not be immediately available in all healthcare settings. Moreover, unstable patients often cannot tolerate delays associated with CT acquisition (13,14). These limitations highlighted the need for a rapid, repeatable bedside imaging modality that could be integrated into the initial trauma assessment without interrupting ongoing resuscitation, ultimately leading to the widespread adoption of focused ultrasonography in trauma care (15). Point-of-Care Ultrasound in Trauma Point-of-Care Ultrasound (POCUS) has become an integral component of contemporary trauma management because it enables rapid bedside assessment without interrupting ongoing resuscitation. The introduction of the Focused Assessment with Sonography for Trauma (FAST) examination during the 1990s marked a major advance in trauma diagnostics by allowing rapid detection of free intraperitoneal and pericardial fluid suggestive of significant internal injury (16). Subsequently, the examination evolved into the Extended Focused Assessment with Sonography for Trauma (eFAST), incorporating assessment of the pleural spaces for pneumothorax and hemothorax, thereby improving the evaluation of thoracoabdominal trauma (17). Owing to its portability, absence of ionizing radiation, repeatability and ability to provide real-time information, POCUS has been incorporated into modern trauma algorithms and is recommended by contemporary trauma guidelines as an adjunct to the primary survey (9,18). Beyond diagnosis, POCUS has the potential to influence immediate clinical decision-making by identifying patients requiring urgent operative intervention while minimizing delays in definitive management. However, its diagnostic performance may vary according to operator experience, patient characteristics and injury pattern. Although the diagnostic accuracy of FAST and eFAST has been extensively investigated, comparatively fewer studies have examined whether POCUS translates into improved surgical decision-making and better patient-centred outcomes (19). RATIONALE OF THE PRESENT STUDY Although POCUS is now widely accepted as an important adjunct in trauma evaluation, there is limited prospective evidence examining its impact beyond diagnostic accuracy. Whether early bedside ultrasound leads to faster surgical decision-making and improved clinical outcomes compared with conventional diagnostic pathways remains insufficiently explored, particularly in Indian emergency departments. Therefore, the present study was undertaken to compare POCUS-guided assessment with conventional diagnostic evaluation in polytrauma patients requiring emergency surgical management, with emphasis on diagnostic accuracy, time to intervention and patient outcomes. LITERATURE REVIEW The introduction of the Focused Assessment with Sonography for Trauma (FAST) examination represented a major advancement in trauma imaging by enabling rapid bedside detection of free intraperitoneal fluid without interrupting resuscitation. Subsequent development of the Extended FAST (eFAST) expanded its role to include assessment for pneumothorax and hemothorax, thereby improving the evaluation of thoracoabdominal injuries. Owing to its portability, repeatability and immediate availability, POCUS has become an established component of contemporary trauma assessment and is recommended as an adjunct to the primary survey in major trauma guidelines (16,17). Diagnostic Accuracy of POCUS Several prospective studies and systematic reviews have demonstrated that FAST and eFAST possess high specificity and good overall diagnostic performance for detecting clinically significant thoracoabdominal injuries in trauma patients. Their greatest utility has been reported in haemodynamically unstable patients, where rapid bedside imaging facilitates early identification of injuries requiring urgent intervention. However, the sensitivity of POCUS varies according to injury pattern, operator expertise and the amount of free fluid present, indicating that a negative examination should not be used to exclude significant injury in all clinical situations (18,19). POCUS and Surgical Decision-Making Beyond its diagnostic role, POCUS has increasingly been recognized as a valuable tool for expediting trauma management. Previous studies have shown that bedside ultrasonography shortens the time to diagnosis and assists clinicians in making earlier operative decisions, particularly in patients with suspected internal haemorrhage. Nevertheless, most published studies have primarily evaluated diagnostic accuracy, while comparatively few have examined its influence on surgical decision-making and clinically meaningful outcomes such as time to intervention, intensive care utilization, postoperative complications and mortality (19,20). Effect of POCUS on Clinical Outcomes Evidence regarding the effect of POCUS on patient outcomes remains limited. Although several studies have reported reductions in diagnostic delays and more efficient trauma workflow, improvements in hospital stay, postoperative complications, transfusion requirements and mortality have not been consistently demonstrated across different clinical settings. These inconsistencies highlight the need for further prospective comparative studies evaluating the broader clinical impact of POCUS, particularly in resource-constrained tertiary care centres (20). Knowledge Gap Despite substantial evidence supporting the diagnostic utility of FAST and eFAST, several important gaps remain. Most published studies have primarily evaluated diagnostic accuracy rather than examining whether POCUS directly influences surgical decision-making and patient-centred outcomes. Furthermore, many investigations have been conducted in high-resource trauma centres with well-established imaging infrastructure, limiting the generalisability of their findings to resource-constrained settings. Prospective comparative evidence from Indian tertiary care hospitals evaluating real-time POCUS-guided assessment against conventional diagnostic pathways is still limited. Data addressing its effect on time to surgery, postoperative outcomes and overall clinical management remain scarce. The existing literature establishes POCUS as a rapid and reliable bedside imaging modality for trauma assessment, with well-documented diagnostic accuracy. However, evidence regarding its impact on surgical decision-making and patient-centred clinical outcomes remains limited, particularly from prospective studies in resource-constrained settings. These gaps provided the rationale for undertaking the present study. RESEARCH QUESTION Does the use of real-time Point-of-Care Ultrasound (POCUS) in polytrauma patients improve surgical decision-making, reduce time to surgical intervention and enhance clinical outcomes compared to conventional diagnostic methods in a tertiary care emergency setting? AIM AND OBJECTIVES AIM To evaluate the impact of Real-Time Point-of-Care Ultrasound (POCUS) on surgical decision-making and time to intervention in polytrauma patients requiring emergency surgical management OBJECTIVES • To assess the diagnostic accuracy of POCUS (FAST/e-FAST) in detecting injuries requiring surgical intervention in polytrauma patients. • To compare clinical outcomes such as hospital stay duration, ICU admission rates, postoperative complications and in-hospital mortality between POCUS-guided and non-POCUS-guided groups. HYPOTHESES Null Hypothesis (H₀) POCUS has no significant impact on surgical decision-making, time to intervention, or clinical outcomes in polytrauma patients. Alternative Hypothesis (H₁) POCUS significantly improves surgical decision-making, reduces time to intervention and enhances clinical outcomes in polytrauma patients.

Study Design and Setting This prospective comparative observational study was conducted in the Department of General Surgery and Emergency Trauma Services of a tertiary care teaching hospital with dedicated 24-hour emergency surgical, radiological and intensive care facilities. The study was carried out over a period of 18 months to evaluate the impact of real-time Point-of-Care Ultrasound (POCUS) on surgical decision-making and clinical outcomes in polytrauma patients. Study Population The study included 200 consecutive adult polytrauma patients presenting to the emergency department with blunt or penetrating trauma requiring emergency surgical evaluation. Of these, 100 patients were managed using a real-time POCUS-guided diagnostic pathway and 100 patients underwent conventional diagnostic imaging, based on the initial imaging strategy adopted in the emergency department. Inclusion Criteria • Age ≥18 years. • Polytrauma (injuries involving ≥2 body regions) caused by RTAs or other mechanisms. • Requiring emergency surgical intervention (e.g., laparotomy, thoracotomy). • Consent provided by patient or legal guardian. Exclusion Criteria • Non-trauma-related injuries. • Patients refusing consent. • Patients dead on arrival. • Cases with incomplete data or transferred before surgical evaluation. Study Procedure Following primary assessment according to the Advanced Trauma Life Support (ATLS®) protocol, all patients underwent standardized resuscitation and clinical evaluation. Patients in the POCUS group received bedside FAST/eFAST examination immediately after initial stabilization. The examination included assessment of Morrison's pouch, splenorenal recess, pelvic cavity, pericardium and bilateral pleural spaces for the presence of free fluid, pneumothorax, or hemothorax. Examinations were performed by trained surgical residents or consultant radiologists and findings were documented in real time. Patients in the conventional imaging group underwent evaluation using conventional diagnostic modalities, including contrast-enhanced computed tomography and other radiological investigations as clinically indicated. Decisions regarding operative or non-operative management were based on hemodynamic status, clinical findings, imaging results and institutional trauma protocols. Operative findings, whenever available, together with the final clinical diagnosis served as the reference standard. All patients were followed until hospital discharge or death. Study Variables and Outcome Measures Demographic characteristics (age and sex), injury-related variables (mechanism and type of trauma), physiological parameters (blood pressure, heart rate, respiratory rate, oxygen saturation, Glasgow Coma Scale, Injury Severity Score and hemodynamic status), diagnostic findings, operative details and clinical outcomes were prospectively recorded using a standardized data collection proforma. The primary outcome measures were the diagnostic accuracy of POCUS compared with conventional imaging, time to surgical decision and time to definitive surgical intervention. Secondary outcomes included intensive care unit admission, duration of ICU stay, length of hospital stay, packed red blood cell transfusion requirement, postoperative complications and in-hospital mortality. Sample Size The sample size was determined during the study planning phase based on the assumptions specified in the approved study protocol, considering a two-sided significance level (α) of 0.05, a statistical power of 80% (1−β), an estimated 20% prevalence of POCUS-detectable injuries and an anticipated 30% reduction in time to surgical intervention in the POCUS group. Based on these assumptions, a minimum sample size of 200 patients was considered adequate to detect a clinically meaningful difference between the study groups. Accordingly, 100 patients were enrolled in the POCUS-guided assessment group and 100 patients in the conventional imaging group, with allowance for potential attrition due to incomplete data or protocol deviations. Statistical Analysis Data were analysed using IBM SPSS Statistics version 25.0 IBM Corp., Armonk, NY, USA. Continuous variables were expressed as mean ± standard deviation or median (interquartile range), while categorical variables were summarized as frequencies and percentages. Comparisons between the two groups were performed using the independent-samples t-test or Mann–Whitney U test for continuous variables and the Chi-square test or Fisher's exact test for categorical variables, as appropriate. The diagnostic performance of POCUS was evaluated by calculating sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and corresponding 95% confidence intervals. A two-tailed p-value of <0.05 was considered statistically significant. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the overall diagnostic performance of POCUS. Ethical Considerations The study was approved by the Institutional Ethics Committee before commencement of patient recruitment and was conducted in accordance with the ethical principles of the Declaration of Helsinki. Written informed consent was obtained from all participants or their legally authorized representatives. Patient confidentiality was maintained throughout the study and participation did not influence the standard of trauma care provided.

Baseline Characteristics A total of 200 polytrauma patients were included in the study, with 100 patients each in the POCUS and conventional imaging groups. The baseline demographic and clinical characteristics of the study population are presented in Table 1. The two groups were comparable with respect to age, sex distribution, Injury Severity Score (ISS), systolic blood pressure, heart rate, respiratory rate, oxygen saturation and hemodynamic status (all p > 0.05). However, the conventional imaging group had significantly higher mean diastolic blood pressure and Glasgow Coma Scale (GCS) scores than the POCUS group (p = 0.047 and p < 0.001, respectively). Table 1. Baseline characteristics of the study population Variable POCUS (n = 100) Conventional Imaging (n = 100) Statistical test p-value Age (years) 40.76 ± 12.50 38.08 ± 12.55 Independent t-test 0.132 Male sex, n (%) 71 (71.0) 63 (63.0) Chi-square test 0.292 Injury Severity Score (ISS) 20.79 ± 7.79 19.62 ± 7.04 Independent t-test 0.266 Systolic blood pressure (mmHg) 102.36 ± 15.48 103.59 ± 15.06 Independent t-test 0.570 Diastolic blood pressure (mmHg) 65.14 ± 10.67 68.18 ± 10.79 Independent t-test 0.047 Heart rate (beats/min) 106.21 ± 16.65 105.63 ± 15.17 Independent t-test 0.797 Respiratory rate (breaths/min) 22.87 ± 4.51 23.34 ± 3.54 Independent t-test 0.413 Oxygen saturation (SpO₂, %) 95.76 ± 3.09 95.38 ± 2.76 Independent t-test 0.360 Glasgow Coma Scale (GCS) 13.80 ± 1.69 14.47 ± 0.92 Independent t-test <0.001 Hemodynamically stable, n (%) 62 (62.0) 62 (62.0) Chi-square test 1.000 Injury Characteristics The injury characteristics of the study population are presented in Table 2. Abdominal injuries constituted the majority of trauma cases in both groups, with the liver and spleen being the most frequently injured organs, followed by renal, bowel/mesenteric, thoracic and pancreatic injuries. Most solid organ injuries were classified as Grade II or Grade III. Operative management was performed in 54.0% of patients in the POCUS group and 48.0% of patients in the conventional imaging group. Table 2. Injury Characteristics of the Study Population Variable POCUS (n = 100) Conventional Imaging (n = 100) Statistical Test p-value Organ injured, n (%) Chi-square test 0.006 Liver 32 (32.0) 24 (24.0) Spleen 22 (22.0) 32 (32.0) Kidney 10 (10.0) 20 (20.0) Bowel/Mesentery 14 (14.0) 10 (10.0) Pancreas 0 2 (2.0) Thoracic injuries 8 (8.0) 10 (10.0) Other/No major injury 14 (14.0) 2 (2.0) Injury grade, n (%)* Chi-square test <0.001 Grade I 14 (14.0) 4 (4.0) Grade II 18 (18.0) 35 (35.0) Grade III 14 (14.0) 19 (19.0) Grade IV 4 (4.0) 16 (16.0) Grade V 14 (14.0) 4 (4.0) Not applicable† 36 (36.0) 22 (22.0) Anatomical distribution, n (%) Chi-square test <0.001 Abdominal 74 (74.0) 90 (90.0) Thoracic 14 (14.0) 10 (10.0) Thoracoabdominal 12 (12.0) 0 Initial management, n (%) Chi-square test 0.479 Operative 54 (54.0) 48 (48.0) Conservative 46 (46.0) 52 (52.0) * Injury grades were assigned according to the American Association for the Surgery of Trauma (AAST) Organ Injury Scale for graded solid organ injuries. † Includes injuries without an applicable AAST injury grade, such as bowel/mesenteric injuries, thoracic injuries and patients without major intra-abdominal organ injury Diagnostic Performance of POCUS The diagnostic performance of POCUS for detecting injuries requiring surgical intervention is presented in Table 3. Using operative findings and/or the final clinical diagnosis as the reference standard, POCUS demonstrated a sensitivity of 100.0%, specificity of 52.2%, positive predictive value of 71.1%, negative predictive value of 100.0% and an overall diagnostic accuracy of 78.0%. No false-negative POCUS examinations were observed in the study cohort. Table 3. Diagnostic Performance of POCUS for Detecting Injuries Requiring Surgical Intervention Diagnostic Parameter Value True Positive (TP), n 54 False Positive (FP), n 22 True Negative (TN), n 24 False Negative (FN), n 0 Sensitivity, % 100.0 Specificity, % 52.2 Positive Predictive Value (PPV), % 71.1 Negative Predictive Value (NPV), % 100.0 Overall Diagnostic Accuracy, % 78.0 Impact of POCUS on Surgical Decision-Making Patients evaluated using POCUS achieved significantly shorter time intervals for diagnosis, surgical decision-making and definitive surgical intervention than those managed through the conventional imaging pathway (Table 4). The mean time to diagnosis was 8.28 ± 1.58 minutes in the POCUS group compared with 22.30 ± 4.60 minutes in the conventional imaging group (p < 0.001). Likewise, the mean time to surgical decision (21.48 ± 13.72 vs. 36.42 ± 3.51 minutes) and time to definitive surgical intervention (31.48 ± 13.71 vs. 58.29 ± 3.25 minutes) were significantly shorter in the POCUS group (both p < 0.001). Table 4. Comparison of Time Intervals Between the Study Groups Time Interval POCUS (n = 100) Conventional Imaging (n = 100) Statistical Test p-value Time to diagnosis (min) 8.28 ± 1.58 22.30 ± 4.60 Independent t-test <0.001 Time to surgical decision (min)* 21.48 ± 13.72 36.42 ± 3.51 Independent t-test <0.001 Time to definitive surgical intervention (min)* 31.48 ± 13.71 58.29 ± 3.25 Independent t-test <0.001 *Calculated among patients who underwent operative management (POCUS: n = 54; Conventional imaging: n = 48). Clinical Outcomes The clinical outcomes of patients in the POCUS and conventional imaging groups are summarized in Table 5. ICU admission was required in 38.0% of patients in the POCUS group and 42.0% of patients in the conventional imaging group (p = 0.665). The mean ICU stay was 5.53 ± 2.74 days in the POCUS group compared with 3.76 ± 1.71 days in the conventional imaging group (p = 0.178). Similarly, there were no statistically significant differences between the two groups with respect to hospital stay (p = 0.058), PRBC transfusion requirement (p = 0.231), or postoperative complications (p = 0.232). In-hospital mortality was observed in 12.0% of patients in the POCUS group, whereas no deaths occurred in the conventional imaging group and this difference was statistically significant (p < 0.001). Table 5. Comparison of Clinical Outcomes Between the Study Groups Outcome POCUS (n = 100) Conventional Imaging (n = 100) Statistical Test p-value ICU admission, n (%) 38 (38.0) 42 (42.0) Chi-square test 0.665 ICU stay (days)* 5.53 ± 2.74 3.76 ± 1.71 Independent t-test 0.178 Hospital stay (days) 8.70 ± 4.77 7.60 ± 3.23 Independent t-test 0.058 PRBC transfusion (units) 1.40 ± 1.68 1.14 ± 1.36 Independent t-test 0.231 Postoperative complications, n (%) 26 (26.0) 18 (18.0) Chi-square test 0.232 In-hospital mortality, n (%) 12 (12.0) 0 (0.0) Fisher's exact test <0.001 *Calculated among patients admitted to the ICU

Principal Findings The present prospective comparative study evaluated the role of real-time Point-of-Care Ultrasound (POCUS) in the management of polytrauma patients requiring emergency surgical assessment. The findings demonstrated that POCUS is a highly sensitive bedside diagnostic modality for identifying injuries requiring surgical intervention, achieving a sensitivity and negative predictive value of 100%. More importantly, the use of POCUS significantly reduced the time to diagnosis, surgical decision-making and definitive surgical intervention compared with the conventional imaging pathway. Although most secondary clinical outcomes, including ICU admission, duration of ICU stay, hospital stay, blood transfusion requirement and postoperative complications, were comparable between the two groups, a significant difference in in-hospital mortality was observed. Collectively, these findings suggest that the greatest benefit of POCUS lies in facilitating rapid clinical decision-making without compromising diagnostic accuracy. Comparison with Previous Studies of Diagnostic Accuracy of POCUS The excellent diagnostic performance observed in the present study is consistent with previous evidence supporting the use of FAST and eFAST in trauma care. Rozycki et al. first demonstrated that surgeon-performed ultrasound could accurately identify clinically significant intra-abdominal injuries, establishing its role in emergency trauma evaluation (16). Subsequently, the randomized trial by Melniker et al. and the Cochrane systematic review by Stengel et al. confirmed the excellent diagnostic performance of FAST for detecting clinically significant thoracoabdominal injuries, particularly in haemodynamically unstable patients (19,20). The present study similarly demonstrated excellent sensitivity and negative predictive value, with no false-negative examinations recorded. Although the specificity was comparatively lower because of false-positive examinations, this finding is clinically acceptable, as false-positive examinations generally prompt further evaluation rather than delaying potentially life-saving intervention. Overall, the findings further support the use of POCUS as a reliable first-line imaging modality in the initial assessment of polytrauma patients. Effect of POCUS on Surgical Decision-Making A key finding of the present study was the significant reduction in the time to diagnosis, surgical decision-making and definitive surgical intervention among patients assessed using POCUS. These findings are consistent with the fundamental principle of trauma care that rapid identification of life-threatening injuries facilitates timely intervention. Similar reductions in diagnostic delays have been reported following the integration of FAST into trauma assessment protocols and contemporary emergency ultrasound guidelines (18,19). In resource-limited settings, where immediate access to computed tomography may not always be feasible, bedside POCUS provides rapid diagnostic information without interrupting ongoing resuscitation. The significantly shorter diagnostic and operative time intervals observed in the present study further support the role of POCUS in expediting early surgical decision-making during the initial evaluation of polytrauma patient. Effect of POCUS on Clinical Outcomes Despite the significant reduction in diagnostic and operative delays, the present study did not demonstrate statistically significant differences between the POCUS and conventional imaging groups with respect to ICU admission, duration of ICU stay, hospital stay, blood transfusion requirement, or postoperative complications. These findings suggest that while POCUS facilitates earlier diagnosis and timely surgical intervention, subsequent clinical outcomes are likely influenced by multiple factors, including injury severity, associated injuries, physiological status at presentation and the quality of definitive trauma care. Similar observations have been reported in prospective studies and systematic reviews, where improvements in diagnostic efficiency did not consistently translate into better short-term clinical outcomes (19,20). However, a significant difference in in-hospital mortality was observed between the two groups, although this finding should be interpreted cautiously because mortality in polytrauma patients is multifactorial and may also reflect differences in injury patterns and baseline clinical characteristics. Clinical Implications The findings of the present study support the incorporation of real-time POCUS into the initial assessment of polytrauma patients, particularly in emergency departments managing haemodynamically unstable patients. POCUS provides rapid bedside diagnostic information without interrupting ongoing resuscitation, thereby facilitating earlier surgical decision-making and reducing delays to definitive intervention. Its portability, ease of repeatability and relatively low cost make it particularly valuable in resource-constrained settings where immediate access to advanced imaging may be limited. Nevertheless, POCUS should be considered an adjunct to comprehensive clinical assessment and, where appropriate, definitive radiological investigations rather than a replacement for them. Strengths and Limitations The present study has several strengths. It employed a prospective comparative design with equal numbers of patients in the POCUS and conventional imaging groups and evaluated clinically relevant outcomes, including diagnostic accuracy, time to intervention and postoperative outcomes. The use of standardized trauma assessment protocols and operative findings or final clinical diagnosis as the reference standard further strengthened the validity of the results. However, certain limitations should be acknowledged. The study was conducted at a single tertiary care centre, which may limit the generalizability of the findings. Although efforts were made to standardize trauma management, operator experience may have influenced POCUS interpretation. In addition, the sample size may have been insufficient to detect significant differences in some secondary clinical outcomes and long-term patient outcomes were not evaluated. Future multicentre studies with larger sample sizes are warranted to further define the impact of POCUS on patient-centred outcomes and trauma system performance

The present study demonstrated that real-time Point-of-Care Ultrasound (POCUS) is a reliable and effective bedside imaging modality for the initial assessment of polytrauma patients. POCUS showed excellent diagnostic performance and significantly reduced the time to diagnosis, surgical decision-making and definitive surgical intervention compared with the conventional imaging pathway. Although most clinical outcomes were comparable between the study groups, the findings highlight the value of POCUS in expediting trauma evaluation and facilitating timely surgical management. Routine integration of POCUS into emergency trauma protocols, particularly in resource-constrained settings, may enhance the efficiency of trauma care and support early clinical decision-making. Further multicentre studies with larger sample sizes are warranted to validate these findings and assess their long-term impact on patient outcomes

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