eFAST exam errors at a level 1 trauma center: A retrospective cohort study

Khosravian, Kiana; Boniface, Keith; Dearing, Elizabeth; Drake, Aaran; Ogle, Kathleen; Pyle, Matthew; Frasure, Sarah E.

doi:10.1016/j.ajem.2021.07.036

Cited by 8 publications

(8 citation statements)

References 24 publications

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“…The E‐FAST protocol provided the largest number of false‐positive and false‐negative results in patients with trauma. However, the sensitivity and specificity values calculated in the present study for the presence of abdominal effusion are comparable to those of Khosravian et al 45 and the meta‐analysis by Netherton et al 55 In that study, two false‐positive findings were reported due to the presence of visceral fat that had been incorrectly declared as fluid. This finding, known as a “double line sign” (DLS), is a relatively common finding, accounting for 27% of diagnostic errors 56 .…”

Section: Discussionsupporting

confidence: 88%

“…However, the sensitivity and specificity values calculated in the present study for the presence of abdominal effusion are comparable to those of Khosravian et al 45 and the meta-analysis by Netherton et al 55 In that study, two false-positive findings were reported due to the presence of visceral fat that had been incorrectly declared as fluid.…”

Section: Discussionsupporting

confidence: 87%

“…The accuracy reported in this study is better than those of Maw et al 41 in their meta‐analysis of six studies comparing ultrasound diagnosis with definitive diagnosis of heart failure made by combining clinical, echocardiographic, and laboratory tests in 1827 patients, with a sensitivity and specificity of 88% and 90%, respectively. This study confirms that the presence of diffuse, homogeneously distributed B‐lines with or without bilateral pleural effusion in a patient with dyspnoea is an excellent sonographic indicator for the diagnosis of heart failure 42–45 . In this study, the specificity and +LR of POCUS for the diagnosis of pneumothorax were higher than the values obtained in a systematic review by Staub et al 46 for traumatic pneumothorax, and the absence of pleural sliding and/or pulmonary spots had a specificity of 100%, as there were no false positives.…”

Section: Discussionsupporting

confidence: 81%

“…This study confirms that the presence of diffuse, homogeneously distributed B-lines with or without bilateral pleural effusion in a patient with dyspnoea is an excellent sonographic indicator for the diagnosis of heart failure. [42][43][44][45] In this study, the specificity and +LR of POCUS for the diagnosis of pneumothorax were higher than the values obtained in a systematic review by Staub et al 46 for traumatic pneumothorax, and the absence of pleural sliding and/or pulmonary spots had a specificity of 100%, as there were no false positives. The same specificity was reported by Khosravian et al, 47 where PNX was only evaluated using the E-FAST protocol, and by Soldati et al, 46 as the only false positive result was from a false evaluation of the lung point on the pleura at the heart level.…”

Section: Discussioncontrasting

confidence: 69%

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Diagnostic accuracy of Point Of Care UltraSound (POCUS) in clinical practice: A retrospective, emergency department based study

Spampinato,

Luppi,

Cristofaro

et al. 2023

J of Clinical Ultrasound

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AimsPoint‐of‐care ultrasound (POCUS) is the acquisition and interpretation of ultrasound imaging at the bedside to solve specific clinical questions based on signs and symptoms of presentation. While several studies evaluated POCUS diagnostic accuracy for a variety of clinical pictures in the emergency department (ED), only a few data are available on POCUS diagnostic accuracy performed by physicians with different POCUS skills. The objective of this research was to evaluate the diagnostic accuracy of POCUS compared to standard diagnostic imaging in the ED.Materials and MethodsThis was a retrospective study conducted in the ED of a third‐level university hospital. Patients who underwent cardiac, thoracic, abdominal, or venous lower limb POCUS and a standard imaging examination between June 2021 and January 2022 were included.Results1047 patients were screened, and 844 patients included. A total of 933 POCUS was included (102, 12.09%, cardiac; 466, 55.21%, thoracic; 336, 39.8%, abdominal; 29, 3.44%, lower limb venous POCUS), accounting for 2029 examinations. POCUS demonstrated 96.6% (95% CI 95.72–97.34) accuracy, 47.73 (95% CI 33.64–67.72) +LR, 0.09 (95% CI 0.06–0.12) −LR. +LR was greater than 10 for all investigations but for hydronephrosis (5.8), and −LR never exceeded 0.4.ConclusionsPOCUS exhibited high diagnostic accuracy for virtually all conditions when performed by emergency department physicians.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 81%

Section: Discussioncontrasting

confidence: 69%

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Diagnostic accuracy of Point Of Care UltraSound (POCUS) in clinical practice: A retrospective, emergency department based study

Spampinato,

Luppi,

Cristofaro

et al. 2023

J of Clinical Ultrasound

View full text Add to dashboard Cite

show abstract

“…This nding needs to be correlated with ndings from clinical studies. A review of EFAST scans in trauma patients found that the most common cause of false negative scans was missing free uid in the pelvis, right hypochondrium, or left hypochondrium, with 31% of these false negative scans necessitating operative or interventional radiology procedures [21]. This highlights the clinical relevance of conducting complete scans, including a proper fanning technique.…”

Section: Discussionmentioning

confidence: 99%

Medical Students' Competency in EFAST Components: a prospective observational study

Farooq,

CEVIK,

ALAO

et al. 2024

Preprint

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Background Ultrasound training in undergraduate medical education is developing, and its incorporation in the curriculum requires careful planning. Extended Focused Assessment Sonography for Trauma (EFAST) is commonly taught to medical students as one of the primary applications of ultrasound. Because false negative EFAST scans can affect patient clinical outcomes, it is essential to evaluate the individual components of this skill. We aim to determine which suboptimal EFAST components students perform after initial training. Methods In this prospective observational study, 90 medical students from two final-year cohorts were assessed in EFAST components after uniform training during the emergency medicine clerkship. All validated components of the standard EFAST exam were assessed. Descriptive analysis in individual components of EFAST was performed. Results The hepatorenal space, splenorenal space, and pelvic space fluid investigations had the lowest completion rates. Pericardial fluid, pelvic free fluid, and right thoracic pleural fluid investigations were most often incorrectly applied. Fanning was most commonly missed in hepatorenal, splenorenal, and pelvic free fluid investigations. Between 12% and 50% of EFAST components had omitted reporting. Conclusions There were significant numbers of incomplete assessments for free intraperitoneal fluid, mostly due to a lack of fanning in the hepatorenal, splenorenal, and pelvic areas. By targeting these challenging areas, trainers can effectively enhance student performance and outcomes. Further research might reveal whether residents and physicians show similar trends in EFAST completion.

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Point‐of‐Care‐Ultrasound Quality Assurance Data from Fellow‐Performed Exams in a Pediatric Emergency Department

Arand,

Noble,

Haber

et al. 2024

J of Ultrasound Medicine

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ObjectivesPoint‐of‐care‐ultrasound (POCUS) is increasingly used by pediatric emergency medicine (PEM) fellows, but scant data exists on the accuracy of exam interpretations. Our goal was to determine whether agreement on exam interpretation between quality assurance (QA) faculty (reference standard) and PEM fellows varied by fellowship year or exam type.MethodsRetrospective review of fellow‐performed POCUS exams between January 2019 and June 2022. Negative binomial (NB) random effects regression was used to account for longitudinal measurement of individual fellow performance across 3 years. Fixed effects were exam type and fellowship year. To assess between‐ and within‐user variability across time, a random intercept and slope were included for each fellow.ResultsExactly 3032 exams, performed by 24 fellows, were included. Raw proportion agreement by fellowship year was high for all exam types (≥88%). From the NB model, there was no statistically significant effect of fellowship year on the mean count of agreement. The relative risk (RR) of agreement for exam types was greatest for cardiac vs other types. The standard deviations for the random intercept and random slope were 0.09 and 0.04, respectively, with a correlation of −0.94.ConclusionsPEM fellows generally interpret exams correctly, with little variation through fellowship, although those who began with more basic skills showed more progress over time. Fellowship year did not influence the likelihood of correct interpretation but there was variation across exam type, with the best agreement for cardiac exams. The extent to which disagreements between fellows and QA faculty represent clinically significant errors requires further study.

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eFAST exam errors at a level 1 trauma center: A retrospective cohort study

Cited by 8 publications

References 24 publications

Diagnostic accuracy of Point Of Care UltraSound (POCUS) in clinical practice: A retrospective, emergency department based study

Diagnostic accuracy of Point Of Care UltraSound (POCUS) in clinical practice: A retrospective, emergency department based study

Medical Students' Competency in EFAST Components: a prospective observational study

Point‐of‐Care‐Ultrasound Quality Assurance Data from Fellow‐Performed Exams in a Pediatric Emergency Department

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