Accuracy of Extended Focused Assessment with Sonography in Trauma (e-FAST) Performed by Emergency Medicine Residents in a Level One Tertiary Center of India.

Advanced Journal of Emergency Medicine Pub Date : 2018-03-03 eCollection Date: 2018-01-01 DOI:10.22114/ajem.v0i0.69
Arpith Easo Samuel, Anoop Chakrapani, Fabith Moideen
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引用次数: 7

Abstract

Introduction: It could be claimed that extended focused assessment with sonography for trauma (e-FAST) is the most important use of ultrasound in every emergency department (ED). It is a rapid, repeatable, non-invasive bedside method that was designed to answer one single question, which is, "whether free fluid is present in the peritoneal, pleural and pericardial cavity or not?" This examination may also be used to evaluate the lungs for pneumothorax.

Objective: The current comparative study was conducted to assess the accuracy and reproducibility of e-FAST performed by emergency medicine residents (EMRs) and radiology consultants (RCs) in multiple trauma patients.

Method: This diagnostic accuracy study was conducted prospectively in patients presenting over a period of 12 months from January 1, 2013, to December 31, 2013 to the ED of Kerala Institute of Medical Sciences (KIMS), Kerala, India. All multiple trauma patients older than 18 years of age presenting within 24 hours of their traumatic event, who underwent both e-FAST and thoracoabdominal computed tomography (CT) scan were included. The e-FAST exams were first performed by the EMRs and then by RCs. The thoracoabdominal CT scan findings were considered as the gold standard. The results were compared between both groups to assess the inter-observer variability. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated both for EMRs and RCs.

Results: In the study period, 150 patients with a mean age of 42.06 ± 18.1 years were evaluated (76.7% male). Only 19 cases (12.7%) had a history of fall from a height, and the others were admitted due to RTA. Thirty-four cases (22.7%) did not require surgery; but the others underwent various interventions. Both EMRs and RCs reported positive findings in 20 cases (13.3%) and negative findings in 130 cases (86.7%). The correlation of e-FAST done by EMRs with that by RCs was 100%. E-FAST exam had a sensitivity of 90.4%, specificity 99.2%, PPV 95.0%, NPV 98.4%, and accuracy 98%, both for EMRs and RCs.

Conclusion: Based on the findings, the sensitivity, specificity, and accuracy of e-FAST exams performed by EMRs were equal to those performed by RCs. It seems that e-FAST performed by EMRs were almost accurate during the initial trauma resuscitation in the ED of a level one trauma center in India.

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印度一级三级中心急诊医学住院医师进行的创伤超声成像扩展聚焦评估(e-FAST)的准确性。
引言:可以说,超声创伤扩展聚焦评估(e-FAST)是超声在每个急诊科(ED)最重要的应用。这是一种快速、可重复、无创的床边方法,旨在回答一个单一的问题,即“腹膜、胸膜和心包腔内是否存在游离液体?”这种检查也可用于评估肺部是否存在肺气肿。目的:本比较研究旨在评估急诊住院医师(EMR)和放射科顾问(RC)在多发性创伤患者中进行e-FAST的准确性和可重复性。方法:本诊断准确性研究前瞻性地对2013年1月1日至2013年12月31日在印度喀拉拉邦喀拉拉邦医学科学研究所(KIMS)ED就诊的12个月内的患者进行。包括所有在创伤事件发生后24小时内出现的18岁以上的多发性创伤患者,他们接受了e-FAST和胸腹计算机断层扫描(CT)。e-FAST检查首先由EMR执行,然后由RC执行。胸腹CT扫描结果被认为是金标准。比较两组之间的结果,以评估观察者之间的变异性。计算EMR和RC的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)和准确性。结果:在研究期间,评估了150名平均年龄为42.06±18.1岁的患者(76.7%为男性)。只有19例(12.7%)有高空坠落史,其他病例因RTA入院。34例(22.7%)不需要手术;但其他人则接受了各种干预。电子病历和随机对照均报告阳性结果20例(13.3%),阴性结果130例(86.7%)。电子病历的e-FAST与随机对照的相关性为100%。E-FAST检查对电子病历和随机对照的敏感性为90.4%,特异性为99.2%,PPV为95.0%,NPV为98.4%,准确率为98%。在印度一级创伤中心急诊室的最初创伤复苏过程中,电子病历进行的e-FAST似乎几乎是准确的。
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