Accuracy of Extended Focused Assessment with Sonography in Trauma (e-FAST) Performed by Emergency Medicine Residents in a Level One Tertiary Center of India

  • Arpith Easo Samuel Department of Emergency Medicine, Kerala Institute of Medical Sciences, Kerala, India.
  • Anoop Chakrapani Department of Emergency Medicine, Kerala Institute of Medical Sciences, Kerala, India.
  • Fabith Moideen Department of Emergency Medicine, Baby Memorial Hospital, Kerala, India.
Keywords: Emergency service, hospital, Multiple trauma, Patient care, Radiologists, Ultrasonography

Abstract

Introduction: It could be claimed that extended focused assessment with sonography for trauma (e-FAST) is the most important use of ultrasound in every emergency department (ED). It is a rapid, repeatable, non-invasive bedside method that was designed to answer one single question, which is, “whether free fluid is present in the peritoneal, pleural and pericardial cavity or not?” This examination may also be used to evaluate the lungs for pneumothorax. Objective: The current comparative study was conducted to assess the accuracy and reproducibility of e-FAST performed by emergency medicine residents (EMRs) and radiology consultants (RCs) in multiple trauma patients. Method: This diagnostic accuracy study was conducted prospectively in patients presenting over a period of 12 months from January 1, 2013, to December 31, 2013 to the ED of Kerala Institute of Medical Sciences (KIMS), Kerala, India. All multiple trauma patients older than 18 years of age presenting within 24 hours of their traumatic event, who underwent both e-FAST and thoracoabdominal computed tomography (CT) scan were included. The e-FAST exams were first performed by the EMRs and then by RCs. The thoracoabdominal CT scan findings were considered as the gold standard. The results were compared between both groups to assess the inter-observer variability. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated both for EMRs and RCs. Results: In the study period, 150 patients with a mean age of 42.06 ± 18.1 years were evaluated (76.7% male). Only 19 cases (12.7%) had a history of fall from a height, and the others were admitted due to RTA. Thirty-four cases (22.7%) did not require surgery; but the others underwent various interventions. Both EMRs and RCs reported positive findings in 20 cases (13.3%) and negative findings in 130 cases (86.7%). The correlation of e-FAST done by EMRs with that by RCs was 100%. E-FAST exam had a sensitivity of 90.4%, specificity 99.2%, PPV 95.0%, NPV 98.4%, and accuracy 98%, both for EMRs and RCs. Conclusion: Based on the findings, the sensitivity, specificity, and accuracy of e-FAST exams performed by EMRs were equal to those performed by RCs. It seems that e-FAST performed by EMRs were almost accurate during the initial trauma resuscitation in the ED of a level one trauma center in India.

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References

1. Abdolrazaghnejad A, Banaie M, Safdari M. Ultrasonography in Emergency Department; a Diagnostic Tool for Better Examination and Decision-Making. Adv J Emerg Med. 2018;2(1):e7.
2. Dolich M, McKenney M, Varela J, Compton R, McKenney K, Cohn S. 2,576 ultrasounds for blunt abdominal trauma. J Trauma. 2001;50(1):108-12.
3. Sloan J, Lalanda M, Brenchley J. Developing the role of emergency medicine ultrasonography. The Leeds experience. Emerg Med J. 2002;19:A63.
4. Hamidi MI, Aldaoud KM, Qtaish I. The Role of Computed Tomography in Blunt Abdominal Trauma. Sultan Qaboos Univ Med J. 2007;7(1):41-6.
5. Karki OB. The Role of Computed Tomography in Blunt Abdominal Trauma. JNMA J Nepal Med Assoc. 2015;53(200):227-30.
6. Williams K, O’Keeffe T. Diagnostic Peritoneal Lavage (DPL) Unplugged. Penetrating Trauma: Springer; 2017. p. 157-63.
7. Nagy KK, Roberts RR, Joseph KT, Smith RF, An GC, Bokhari F, et al. Experience with over 2500 diagnostic peritoneal lavages. Injury. 2000;31(7):479-82.
8. Chereau N, Wagner M, Tresallet C, Lucidarme O, Raux M, Menegaux F. CT scan and Diagnostic Peritoneal Lavage: towards a better diagnosis in the area of nonoperative management of blunt abdominal trauma. Injury. 2016;47(9):2006-11.
9. Richards JR, McGahan JP. Focused Assessment with Sonography in Trauma (FAST) in 2017: What Radiologists Can Learn. Radiology. 2017;283(1):30-48.
10. Grunherz L, Jensen KO, Neuhaus V, Mica L, Werner CML, Ciritsis B, et al. Early computed tomography or focused assessment with sonography in abdominal trauma: what are the leading opinions? Eur J Trauma Emerg Surg. 2018;44(1):3-8.
11. Brooks A, Davies B, Smethhurst M, Connolly J. Prospective evaluation of non-radiologist performed emergency abdominal ultrasound for haemoperitoneum. Emerg Med J. 2004;21(5):e5.
12. Jehangir B, Bhat A, Nazir A. The role of ultrasonography in blunt abdominal trauma. A retrospective study. JK Pract. 2003;10(2):118.
13. Gaarder C, Kroepelien CF, Loekke R, Hestnes M, Dormage JB, Naess PA. Ultrasound performed by radiologists-confirming the truth about FAST in trauma. J Trauma. 2009;67(2):323-7.
14. Maxwell-Armstrong C, Brooks A, Field M, Hammond J, Abercrombie J. Diagnostic peritoneal lavage analysis: should trauma guidelines be revised? Emerg Med J. 2002;19(6):524-5.
15. Kessler DO. Abdominal Ultrasound for Pediatric Blunt Trauma: FAST Is Not Always Better. Jama. 2017;317(22):2283-5.
16. Smith J. Focused assessment with sonography in trauma (FAST): should its role be reconsidered? Postgrad Med J. 2010;86(1015):285-91.
Published
2018-03-03
How to Cite
Samuel, A. E., Chakrapani, A., & Moideen, F. (2018). Accuracy of Extended Focused Assessment with Sonography in Trauma (e-FAST) Performed by Emergency Medicine Residents in a Level One Tertiary Center of India. Advanced Journal of Emergency Medicine, 2(2), e15. https://doi.org/10.22114/ajem.v0i0.69
Section
Original article