Miharu Arase, Negar Nekooei, Marco Sozzi, Morgan Schellenberg, Kazuhide Matsushima, Kenji Inaba, Matthew J Martin
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引用次数: 0
Abstract
Background: The extended focused assessment with sonography in trauma (eFAST) examination includes additional thoracic views beyond the standard focused assessment with sonography in trauma examination. Its validation has predominantly been conducted in blunt trauma cases. Our aim was to evaluate the eFAST examination in a targeted population with penetrating thoracic trauma.
Methods: Patients with thoracic gunshot wounds who underwent eFAST between 2017 and 2021 were included from a local trauma registry. Performance metrics for each component of eFAST in each window and pathological condition were analyzed across the entire population, as well as within two cohorts: survived and deceased patients. Chest tube placement rates were compared within true-positive and false-negative (FN) eFAST results for subgroups with pneumothorax or hemothorax.
Results: A total of 288 patients were included (male, 91% male; Injury Severity Score ≥15, 48%; and died, 17%). Thirty-nine percent required chest tube, and 18% required urgent thoracic surgical intervention. Although specificity was high (91-100%) for all components, the sensitivity was less than 50% for all thoracic views, except for "no cardiac motion" (100% sensitivity). Sensitivity for pericardial fluid was 47%; for pneumothorax, 22%; for hemothorax, 36%; and for peritoneal fluid, 51% in the total population. Comparing survived versus deceased cohort, the eFAST sensitivity was higher among deaths for all components. The majority of patients (>70%) with a FN eFAST for pneumothorax or hemothorax received chest tube.
Conclusion: The eFAST examination showed highly variable performance metrics among patients with penetrating thoracic trauma, with all thoracic components demonstrating high specificity but low overall sensitivity. Urgent interventions were frequently received in patients with FN studies.
Level of evidence: Diagnostic Test/Criteria; Level III.
期刊介绍：
The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.
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