Diagnostic accuracy of E-FAST examination performed by newly trained emergency physicians and its impact on clinical outcomes

Abstract

Background: Extended Focused Assessment with Sonography for Trauma (E-FAST) is considered a critical assessment tool for patients with trauma. This study aimed to investigate the diagnostic accuracy of the E-FAST examination performed by newly trained emergency medicine residents and its effect on clinical outcomes. Methods: Patients with multiple trauma presenting to the adult emergency department of a university hospital were prospectively evaluated. Senior emergency medicine residents with no prior ultrasonography experience were included in the study after completing a 2-day official and nationally certified theoretical and practical course, which also covered E-FAST training, and performing at least 50 E-FAST examinations. Computed tomography (CT) results were accepted as the gold standard, and the sensitivity, specificity, positive and negative predictive values (PPV, NPV), and accuracy of E-FAST were calculated. Clinical outcomes were defined as the need for emergency surgery and, in patients with false-negative (FN) E-FAST evaluations, chest tube placement, hospitalization, and need for surgery. Results: A total of 158 patients were included. For hemoperitoneum, sensitivity was 81.25%, specificity 100%, PPV 100%, NPV 95.45%, accuracy 96.2%, and area under the receiver operating characteristic curve (AUC) 0.91; for hemothorax, sensitivity was 35.71%, specificity 100%, PPV 100%, NPV 94.12%, accuracy 94.3%, and AUC 0.68; and for pneumothorax, sensitivity was 59.38%, specificity 100%, PPV 100%, NPV 90.65%, accuracy 91.77%, and AUC 0.80. None of the six hemoperitoneum patients assessed as FN required a treatment plan for this reason. Chest tubes were placed in 5 of the 9 hemothorax patients assessed as FN due to subsequent hemodynamic instability, and in 4 of the 13 pneumothorax patients due to the need for mechanical ventilation. E-FAST assessment was positive in 7 of the 8 patients requiring emergency surgery. Conclusions: In patients with a positive E-FAST assessment who require emergency surgery, CT scanning should not delay surgical procedures or lead to time loss. Our study demonstrates that when performed by clinical personnel with training and experience, E-FAST provides accurate results with high specificity and correctly identifies patients requiring surgical intervention. Furthermore, in patients with FN results, serial E-FAST assessments can enhance diagnostic accuracy and contribute to improved patient management. Clinical trial number: Not applicable.