The effect of extended-focused assessment with sonography in trauma results on clinical judgment accuracy of the physicians managing patients with blunt thoracoabdominal trauma

Authors

1 Prehospital and Hospital Emergency Research Center; Department of Emergency Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

2 Prehospital and Hospital Emergency Research Center; Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran

3 Prehospital and Hospital Emergency Research Center; Department of Vascular Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran

4 Department of Emergency Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

5 School of Medicine, Islamic Azad University of Medical Sciences, Tehran, Iran

6 School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background: Extended-focused assessment with sonography in trauma (E-FAST) has been introduced as a free fluid identification technique in the abdomen, and currently, like stethoscopes, it is routinely used to assess traumatic patients, as part of physical examination tools. We decided to examine the effect of using E-FAST in the clinical judgment of the physicians managing patients with blunt abdominal and chest wall trauma. Materials and Methods: In this cross-sectional study, all patients who were admitted from May 2014 till May 2015 to the emergency department of Imam Khomeini and Sina Hospitals, Tehran, Iran, with an abdominal or chest blunt trauma and for whom E-FAST was conducted were enrolled. In a preprepared checklist, possible consequences based on the primary clinical judgment of a physician were recorded; and then, the results from E-FAST on existence or nonexistence of free fluid or air in the peritoneal or pleural space were presented, and the possible consequences according to the results obtained from the E-FAST were also recorded again. Based on actual outcome of patients' condition in the first 24 h, statistical characteristics for each pathology were calculated. Results: In this study, 115 patients with a mean age of 36.20 ± 12.37 years were examined including 92 (80%) men. The correlation coefficient between the possibility of hemorrhagic shock, pneumothorax, hemoperitoneum, solid organ damage, and hemothorax before and after the E-FAST based on the Kappa criteria was 0.803, 0.642, 0.430, 0.331, and 0.318, respectively. Conclusion: The results of this study showed that performing E-FAST increases the sensitivity of history and physical examination in diagnosis of pneumothorax, hemoperitoneum, solid organ damage, and hemothorax.

Keywords


1. Schneck E, Koch C, Borgards M, Reichert M, Hecker A, Heiß C, et al. Impact of abdominal follow‑up sonography in trauma patients without abdominal parenchymal organ lesion or Free intraabdominal fluid in whole‑body computed tomography. Rofo 2017;189:128‑36. 
2. Hall MK, Omer T, Moore CL, Taylor RA. Cost‑effectiveness of the cardiac component of the focused assessment of sonography in trauma examination in blunt trauma. Acad Emerg Med 2016;23:415‑23. 
3. Richards JR, McGahan JP. Focused assessment with sonography in trauma (FAST) in 2017: What radiologists can learn. Radiology 2017;283:30‑48. 
4. Elbaih AH, Abu‑Elela ST. Predictive value of focused assessment with sonography for trauma (FAST) for laparotomy in unstable polytrauma Egyptians patients. Chin J Traumatol 2017;20:323‑8. 
5. O׳Keeffe M, Clark S, Khosa F, Mohammed MF, McLaughlin PD, Nicolaou S. Imaging protocols for trauma patients: Trauma series, extended focused assessment with sonography for trauma, and selective and whole‑body computed tomography. Semin Roentgenol 2016;51:130‑42. 
6. Safari S, Radfar F, Baratloo A. Thoracic injury rule out criteria and NEXUS chest in predicting the risk of traumatic intra‑thoracic injuries: A diagnostic accuracy study. Injury 2018;49:959‑62. 
7. Forouzanfar MM, Safari S, Niazazari M, Baratloo A, Hashemi B, Hatamabadi HR, et al. Clinical decision rule to prevent unnecessary chest X‑ray in patients with blunt multiple traumas. Emerg Med Australas 2014;26:561‑6. 
8. Savatmongkorngul S, Wongwaisayawan S, Kaewlai R. Focused assessment with sonography for trauma: Current perspectives. Open Access Emerg Med 2017;9:57‑62. 
9. Sgourakis G, Lanitis S, Korontzi M, Kontovounisios C, Zacharioudakis C, Armoutidis V, et al. Incidental findings in focused assessment with sonography for trauma in hemodynamically stable blunt trauma patients: Speaking about cost to benefit. J Trauma 2011;71:E123‑7. 
10. Smith J. Focused assessment with sonography in trauma (FAST): Should its role be reconsidered? Postgrad Med J 2010;86:285‑91. 
11. Bowra J, Forrest‑Horder S, Caldwell E, Cox M, D’Amours SK. Validation of nurse‑performed FAST ultrasound. Injury 2010;41:484‑7. 
12. Hoffman L, Pierce D, Puumala S. Clinical predictors of injuries not identified by Focused Abdominal Sonogram for Trauma (FAST) examinations. J Emerg Med 2009;36:271‑9. 
13. 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:e7. 
14. Vázquez Martínez JL, Quiñones Coneo KL, Villegas TV, Sánchez Porras M, Macarrón CP, Pérez AC, et al. Applicability of a modified EFAST protocol (r‑EFAST) to evaluate hemodynamically unstable patients after percutaneous cardiac intervention. Crit Ultrasound J 2017;9:12. 
15. Akoglu H, Celik OF, Celik A, Ergelen R, Onur O, Denizbasi A, et al. Diagnostic accuracy of the Extended Focused Abdominal Sonography for Trauma (E‑FAST) performed by emergency physicians compared to CT. Am J Emerg Med 2018;36:1014‑7. 
16. Natarajan B, Gupta PK, Cemaj S, Sorensen M, Hatzoudis GI, Forse RA. FAST scan: Is it worth doing in hemodynamically stable blunt trauma patients? Surgery 2010;148:695‑700. 
17. 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;67:323‑7. 
18. HeW, Xiang DY, DaiJP. Sonography in the 29th Olympic and Paralympic games: A retrospective analysis. Clin Imaging 2011;35:143‑7. 
19. Taylor J, McLaughlin K, McRae A, Lang E, Anton A. Use of prehospital ultrasound in North America: A survey of emergency medical services medical directors. BMC Emerg Med 2014;14:6. 
20. O’Dochartaigh D, Douma M. Prehospital ultrasound of the abdomen and thorax changes trauma patient management: A systematic review. Injury 2015;46:2093‑102. 
21. Dammers D, El Moumni M, Hoogland II, Veeger N, Ter Avest E. Should we perform a FAST exam in haemodynamically stable patients presenting after blunt abdominal injury: A retrospective cohort study. Scand J Trauma Resusc Emerg Med 2017;25:1. 
22. Ojaghi Haghighi SH, Adimi I, Shams Vahdati S, Sarkhoshi Khiavi R. Ultrasonographic diagnosis of suspected hemopneumothorax in trauma patients. Trauma Mon 2014;19:e17498. 
23. Ala AR, Pouraghaei M, Shams Vahdati S, Taghizadieh A, Moharamzadeh P, Arjmandi H. Diagnostic accuracy of focused assessment with sonography for trauma in the emergency department. Trauma Mon 2016;21:e21122. 
24. Williams SR, Perera P, Gharahbaghian L. The FAST and E‑FAST in 2013: Trauma ultrasonography: Overview, practical techniques, controversies, and new frontiers. Crit Care Clin 2014;30:119‑50, vi. 
25. Zieneldin A, Rageh T, Azab S, Elgndy N. Positive focused assessment sonography as an indication for laparotomy in hemodynamically unstable blunt traumatized patient. Menoufia Med J 2017;30:400‑4. 
26. Iqbal Y, Taj MN, Ahmed A, Ur Rehman Z, Akbar Z. Validity of the fast scan for diagnosis of intraabdominal injury in blunt abdominal trauma. J Ayub Med Coll Abbottabad 2014;26:52‑6. 
27. Radwan MM, Abu‑Zidan FM. Focussed Assessment Sonograph Trauma (FAST) and CT scan in blunt abdominal trauma: Surgeon’s perspective. Afr Health Sci 2006;6:187‑90. 
28. Kong VY, Jeetoo D, Naidoo LC, Oosthuizen GV, Clarke DL. Isolated free intra‑abdominal fluid on CT in blunt trauma: The continued diagnostic dilemma. Chin J Traumatol 2015;18:357‑9. 
29. Nandipati KC, Allamaneni S, Kakarla R, Wong A, Richards N, Satterfield J, et al. Extended focused assessment with sonography for trauma (EFAST) in the diagnosis of pneumothorax: Experience at a community based level I trauma center. Injury 2011;42:511‑4. 
30. Terry BM, Blehar D, Gaspari R, Maydell AT, Bezuidenhout FA, Andronikou S. FAST as a predictor of clinical outcome in blunt abdominal trauma. S Afr J Radiol 2011;15:108-15.
31. Ianniello S, Di Giacomo V, Sessa B, Miele V. First‑line sonographic diagnosis of pneumothorax in major trauma: Accuracy of e‑FAST and comparison with multidetector computed tomography. Radiol Med 2014;119:674‑80. 
32. Becker A, Lin G, McKenney MG, Marttos A, Schulman CI. Is the FAST exam reliable in severely injured patients? Injury 2010;41:479‑83. 
33. Grünherz L, Jensen KO, Neuhaus V, Mica L, Werner CM, 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;44:3‑8.