eFAST for Pneumothorax: Real-Life Application in an Urban Level 1 Center by Trauma Team Members

Abstract

The focused assessment with sonography for trauma (FAST) examination has become the standard of care for rapid evaluation of trauma patients. Extended FAST (eFAST) is the use of ultra-sonography for the detection of pneumothorax (PTX). The exact sensitivity and specificity of eFAST detecting traumatic PTX during practical “real-life” application is yet to be investigated. This is a retrospective review of all trauma patients with a diagnosis of PTX, who were treated at a large level 1 urban trauma center from March 2013 through July 2014. Charts were reviewed for results of imaging, which included eFAST, chest X-ray, and CT scan. The requirement of tube thoracostomy and mechanism of injury were also analyzed. A total of 369 patients with a diagnosis of PTX were identified. A total of 69 patients were excluded, as eFASTwas either not performed or not documented, leaving 300 patients identified with PTX. A total of 113 patients had clinically significant PTX (37.6%), requiring immediate tube thoracostomy placement. eFAST yielded a positive diagnosis of PTX in 19 patients (16.8%), and all were clinically significant, requiring tube thoracostomy. Chest X-ray detected clinically significant PTX in 105 patients (92.9%). The literature on the utility of eFAST for PTX in trauma is variable. Our data show that although specific for clinically significant traumatic PTX, it has poor sensitivity when performed by clinicians with variable levels of ultrasound training. We conclude that CT is still the gold standard in detecting PTX, and clinicians performing eFAST should have adequate training.

Point-of-care ultrasound (POCUS) practices in the helicopter emergency medical services in Europe: results of an online survey

“…Nevertheless, the evidence regarding improving direct patient outcome is weak which needs properly designed prospective studies [10,11,[13][14][15][16][17][18]. There are different POCUS protocols that can be used in the pre-hospital setting which include extended (e)FAST to search for intraperitoneal fluid, peri-cardiac fluid, haemothorax and pneumothorax, [19,20], Rapid Ultrasound for Shock (RUSH) to define the cause of the shock, and Focused Assessment Transthoracic Echocardigraphy (FATE) or Focused Echocardiography in Emergency Life support (FEEL) to quickly evaluate the cardiac function [21][22][23][24][25]. Our results show, that (e)FAST is the most used protocol in HEMS.…”

​Point-of-Care Ultrasound (POCUS) practices in the Helicopter Emergency Medical Services in Europe

“…Nevertheless, the evidence regarding improving direct patient outcome is weak and needs to be clari ed by properly designed prospective studies [10,11,[13][14][15][16][17][18]. There are different POCUS protocols that can be used in the pre-hospital setting which include extended (e)FAST to search for intraperitoneal uid, peri-cardiac uid, haemothorax and pneumothorax, [19,20], Rapid Ultrasound for Shock (RUSH) to de ne the cause of the shock, and Focused Assessment Transthoracic Echocardigraphy (FATE) to quickly evaluate the cardiac function [21][22][23][24]. Our results show, that (e)FAST is the most used protocol in HEMS.…”

Immediate Pneumothorax Diagnosis by Surgical Residents Using Portable Ultrasound

“…High sensitivity and specificity (87% to 98% and 99%, respectively) were reported when performed by trained radiologists or attending-level emergency medicine physicians, 8,19,20 and a significantly lower sensitivity (16.9%) when performed by less-trained physicians. 9 In this study US was performed by 4 surgical residents who underwent a 30-hour US course, who achieved sensitivity and specificity rates as high as 95.65% and 97.44%, respectively. Moreover, this study shows an extremely low interexaminer variation.…”

“…7 In our institution, thoracic US is performed by radiologists at 4 points. As feasibility of this tool among non-radiologists shows inconsistent results, 8,9 the aim of this study is to evaluate the feasibility and accuracy of 2-point evaluation—a shorted and quicker test, using portable US for immediate diagnosis of pneumothorax in the ED setting by non-radiologists who underwent short US training.…”