Diagnostic performance of the extended focused assessment with sonography for trauma (EFAST) patients in a tertiary care hospital of Nepal

Basnet, Sijan; Shrestha, Sanu Krishna; Pradhan, Anju; Shrestha, Ranjana; Shrestha, Anmol Purna; Sharma, Grishma; Bade, Sahil; Giri, Latika

doi:10.1136/tsaco-2020-000438

Cited by 13 publications

(17 citation statements)

References 32 publications

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“…The negative predictive value was 98.53% and the positive predictive value was 98.21% with an overall accuracy of 99.4%. 24 This corresponds to our study results. However, they also stress the fact that negative results need to be reassessed after 4 hours or need evaluation by NCCT.…”

Section: Discussionsupporting

confidence: 92%

Diagnostic Accuracy of e-FAST in Stable Blunt Trauma Chest: A Prospective Analysis of 110 Cases at a Tertiary Care Center

Devadoss¹,

Sharma²,

Nair³

et al. 2022

Indian Journal of Critical Care Medicine

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A bstract Background Focused assessment with sonography in trauma (FAST) is an important adjunct and an extension of the clinical examination in an emergency setting for the last three decades. e-FAST visualizes the lung bases and injuries related to the lungs in addition to the intra-abdominal and pericardial bleed. In trauma patients, time is precious. Noncontrast computed tomography (NCCT) chest is the gold standard for the evaluation of blunt trauma chest. However, it is cumbersome and time-consuming and leads to increased morbidity and mortality. Therefore, evaluation of trauma patients at the trauma bay with e-FAST which is available at all times will not only save time but also the lives of trauma patients. Our endeavor is to find whether e-FAST can be substituted for NCCT for assessing injuries accurately in a stable blunt trauma patient. Patient and methods Prospective observational study was conducted in a tertiary care trauma center during the period of November 2017 to 2019. Of the 197 patients presenting to the trauma surgeon in the trauma center, 110 were included in the study after satisfying the inclusion criteria. Eighty-seven patients being hemodynamically unstable were excluded from the study. Results There was no statistical significance in the comparative data between the groups and all with “ p ” values more than 0.05. This accepts the null hypothesis and establishes the fact that there is no difference between NCCT chest which is the gold standard for chest blunt trauma and e-FAST. Conclusion We conclude that e-FAST is a better adjunct to the diagnosis and management of blunt trauma chest patients. How to cite this article Devadoss H, Sharma P, Nair VV, Rehsi SS, Roy N, Rao PP. Diagnostic Accuracy of e-FAST in Stable Blunt Trauma Chest: A Prospective Analysis of 110 Cases at a Tertiary Care Center. Indian J Crit Care Med 2021;25(10):1167–1172.

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Section: Discussionsupporting

confidence: 92%

Diagnostic Accuracy of e-FAST in Stable Blunt Trauma Chest: A Prospective Analysis of 110 Cases at a Tertiary Care Center

Devadoss¹,

Sharma²,

Nair³

et al. 2022

Indian Journal of Critical Care Medicine

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“…The outcome revealed a sensitivity of 94.8% and a specificity of 99.5% when compared with either additional imaging or intraoperative findings. 8 This study pointed out that nonclinician health-care professionals from a middle-income country who were unfamiliar with scanning ultrasound could perform the EFAST exam effectively. The difference in our study compared with the previous studies may have influenced a slightly lower value of diagnostic performance due to the time limitation for interpreting the ultrasonographic imaging files.…”

Section: Discussionmentioning

confidence: 94%

“…We followed the 2-h style curriculum, which had been proven to be effective among EM residents and paramedics. 8 , 16 The first hour of didactic training included an introduction, ultrasound physics, knobology, and image acquisition. The next hour covered EFAST and pleural ultrasound.…”

Section: Methodsmentioning

confidence: 99%

“… 5–7 Moreover, the accuracy of prehospital pneumothorax detection using EFAST was 82.1%–99.4%. 8 , 9 The EMS system in Thailand was established in 1980. 10 Since then, emergency nurses and physicians have provided prehospital care of patients.…”

Section: Introductionmentioning

confidence: 99%

“…Although several articles have shown the benefit of EFAST for physicians in the prehospital setting, the benefit of performing prehospital EFAST by Thai paramedics has not been investigated. 7 , 8 , 11 , 12 To date, numerous ultrasound curricula have been developed according to the literature, but there has been no standardized training to establish the clinical outcome, especially for the middle-income countries. 13 The duration of the curricula varied from 1 h to 2 days, and most of curricula comprised both didactic lecture and practical session.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Accuracy of Extended Focused Assessment with Sonography for Trauma Performed by Paramedic Students: A Simulation-Based Pilot Study

Buaprasert¹,

Sri‐on²,

Sukhuntee³

et al. 2021

OAEM

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Background Training on how to perform a prehospital extended focused assessment with sonography in trauma (EFAST) has resulted in improved outcomes for trauma patients in several countries. The result of previous studies showed good accuracy despite minimal training. However, data on the diagnostic accuracy among untrained paramedic students and the course length in middle-income countries is scarce. In Thailand, the current paramedic education does not include training on prehospital ultrasounds. In the present study, we aimed to investigate the diagnostic accuracy of EFAST among ultrasound-naïve paramedic students and factors that are associated with successful posttest training. Methods Final-year paramedic students attending a 4-year university program were included in this study. A 2-h didactic training session and 1-h hands-on workshop were led by experienced emergency physicians. The diagnostic indices for EFAST interpretation were obtained pretraining and posttraining. The participants’ ultrasound image acquisition was also evaluated individually on a mannequin model using a standardized assessment tool. Results In total, 47 paramedic students were voluntarily enrolled and underwent EFAST training. Of these participants, 31 (66%) reported having >1 year of experience in the prehospital field. Four were advanced emergency medical technicians before becoming paramedic students. The sensitivity, specificity, positive predictive value, and negative predictive value after training were 85.7% (95% CI, 81.5–89.3), 81.6% (95% CI, 74.2–87.6), 91.6% (95% CI, 87.9–94.4), and 71% (95% CI, 63.3–77.8), respectively. Previous prehospital experience was not associated with accuracy. Conclusion This study demonstrated that paramedic students in Thailand were able to achieve a competency comparable with that of other medical professionals in a simulated environment. The total 3 h training course was sufficient for them to acquire EFAST skills.

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Ascending with ultrasound: telementored eFAST in flight—a feasibility study

Engelsen,

Heyerdahl,

Maddali

et al. 2023

Emerg Radiol

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Purpose Teleultrasound uses telecommunication technologies to transmit ultrasound images from a remote location to an expert who guides the acquisition of images and interprets them in real time. Multiple studies have demonstrated the feasibility of teleultrasound. However, its application during helicopter flight using long-term evolution (LTE) for streaming has not been studied. Therefore, we conducted a study to examine the feasibility of teleultrasound in an Airbus H145 helicopter. Methods Four anesthesiologists and one military physician were recruited to perform telementored extended Focused Assessment with Sonography in Trauma (eFAST) during nine helicopter flights, each with a unique healthy volunteer. A radiologist was recruited as a remote expert, guiding the physicians in their examinations. The examining physicians reported the user experience of telementored eFAST on a questionnaire, while the remote expert rated the diagnostic quality of the images on a 1–5 Likert scale. In addition, we measured the duration of the examinations and key LTE network parameters including signal strength, quality, and continuity. Results The images were rated to an average of 4.9 by the remote expert, corresponding to good diagnostic quality. The average duration of telementored eFAST was 05:54 min. LTE coverage was negatively affected by proximity to urban areas and ceased above 2000 ft altitude. Occasional audio problems were addressed by using the Voice over LTE network for communication. The examining physicians unanimously reported on the questionnaire that they would use telementored eFAST on patients. Conclusion Telementored eFAST is feasible in ambulance helicopters and can produce images of good diagnostic quality. However, it relies on stable LTE coverage, which is influenced by many factors, including the helicopter’s altitude and flight path. Furthermore, its benefit on patient outcomes remains to be proven. Graphical abstract

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Diagnostic performance of the extended focused assessment with sonography for trauma (EFAST) patients in a tertiary care hospital of Nepal

Cited by 13 publications

References 32 publications

Diagnostic Accuracy of e-FAST in Stable Blunt Trauma Chest: A Prospective Analysis of 110 Cases at a Tertiary Care Center

Diagnostic Accuracy of e-FAST in Stable Blunt Trauma Chest: A Prospective Analysis of 110 Cases at a Tertiary Care Center

Diagnostic Accuracy of Extended Focused Assessment with Sonography for Trauma Performed by Paramedic Students: A Simulation-Based Pilot Study

Ascending with ultrasound: telementored eFAST in flight—a feasibility study

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