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Utility of Extended FAST in Blunt Chest Trauma: Is it the Time to be Used in the ATLS Algorithm?

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Abstract

Introduction

The clinical significance of extended Focused Assessment with Sonography for Trauma (EFAST) for diagnosis of pneumothorax is not well defined.

Objectives

To investigate the utility of EFAST in blunt chest trauma (BCT) patients.

Study design

A single blinded, prospective study. Participants: All patients admitted with BCT (2011–2013).

Settings

Level 1 trauma center in Qatar.

Procedures and outcome measures

Patients were screened by EFAST and results were compared to the clinical examination (CE) and chest X-ray (CXR). Chest-computed tomography (CT) scoring system was used to confirm and measure the pneumothorax. Diagnostic accuracy of diagnostic modalities of pneumothorax was measured using sensitivity, specificity, predictive values (PVs), and likelihood ratio.

Results

A total of 305 BCT patients were included with median age of 34 (18–75). Chest CT was positive for pneumothorax in 75 (24.6 %) cases; of which 11 % had bilateral pneumothorax. Chest CT confirmed the diagnosis of pneumothorax in 43, 41, and 11 % of those who were initially diagnosed by EFAST, CE, and CXR, respectively. EFAST was positive in 42 hemithoraces and its sensitivity (43 %) was higher in comparison to CXR (11 %). Positive and negative PVs of EFAST were 76 and 92 %, respectively. The frequency of missed cases by CXR was higher in comparison to EFAST and CE. The lowest median score of missed pneumothorax was observed by EFAST.

Conclusion

EFAST can be used as an efficient triaging tool in BCT patients to rule out pneumothorax. Based on our analysis, we would recommend EFAST as an adjunct in ATLS algorithm.

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Acknowledgments

We thank all the Trauma surgery staff, database registry for their kind cooperation. All authors read the manuscript and approved it and had no financial issues to disclose. Medical Research Center (IRB# 9055/09) at Hamad Medical Corporation, Qatar has approved the study.

Author information

Authors and Affiliations

  1. Trauma Surgery Section, Hamad General Hospital (HGH), P.O Box 3050, Doha, Qatar

    Yassir Abdulrahman, Suhail Y. Hakim, Ahad Qanbar, Ismail Mahmood, Tariq Siddiqui, Hazim H. Ali, Ibrahim Afifi & Hassan Al-Thani

  2. Department of Surgery, HGH, Doha, Qatar

    Shameel Musthafa

  3. Department of Radiology, HGH, Doha, Qatar

    Syed Nabir

  4. Clinical Research (Administrative), University of Qatar, Doha, Qatar

    Wafaa A. Hussein

  5. Clinical Research, Trauma Surgery Section, HGH, Doha, Qatar

    Ayman El-Menyar

  6. Clinical Medicine, Weill Cornell Medical College, Doha, Qatar

    Ayman El-Menyar

Authors
  1. Yassir Abdulrahman
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  2. Shameel Musthafa
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  3. Suhail Y. Hakim
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  4. Syed Nabir
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  5. Ahad Qanbar
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  6. Ismail Mahmood
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  7. Tariq Siddiqui
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  8. Wafaa A. Hussein
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  9. Hazim H. Ali
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  10. Ibrahim Afifi
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  11. Ayman El-Menyar
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  12. Hassan Al-Thani
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Corresponding author

Correspondence to Yassir Abdulrahman.

Additional information

The present study has been accepted for presentation in part in The Trauma Association of Canada Annual Scientific Meeting, April 10–11, 2014 at the Centre Mont-Royal in Montreal, QC, Canada.

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Abdulrahman, Y., Musthafa, S., Hakim, S.Y. et al. Utility of Extended FAST in Blunt Chest Trauma: Is it the Time to be Used in the ATLS Algorithm?. World J Surg 39, 172–178 (2015). https://doi.org/10.1007/s00268-014-2781-y

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  • DOI: https://doi.org/10.1007/s00268-014-2781-y

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