Sensitive of EFAST in trauma in correlation with CT scan

Department of Emergency Medicine and Critical Care, Kauvery Hospital, Trichy-Cantonment, India

Background

Trauma is one of the leading causes of death worldwide. It often involves many organ systems. Major trauma is best managed at dedicated centres. Death from trauma may have a trimodal pattern [1], thus time is precious. Effective management of trauma should be done within the golden window period to reduce morbidity and mortality by following Advance Trauma Life Support protocol. These patients cannot be shifted for imaging as they are haemodynamically unstable requiring resuscitation. Ultrasound in the form of Extended Focused Assessment Sonography for trauma came to the rescue in managing such patients with its advantage of being a bedside procedure, a simple, real-time, noninvasive tool. In the majority of traumatic injuries, death occurs basically because of time delay in diagnosis, often related to the time taken in the transportation of patients with major blunt injuries of the thorax and abdomen. With the use of enhanced focused assessment sonography in trauma, early detection of blunt injury and early resuscitation may help in a better outcome.

E-fast is very reliable and easy to study at the bedside can be repeated multiple times, it is less time-consuming, painless, and very useful in pregnant women where radiation is contraindicated. E-fast is a potential tool allowing for the omission of supine radiography.

The disadvantage is encountered with a major open abdominal injury, super obese patient with poor window, an artifact with the machine, bleeding less than 200 ml, pancreatic injury, and bowel perforation where abnormalities cannot be easily picked up.

EFAST is done in the supine position of the patient, with the help of a curvilinear 2.5-6 mHZ probe. Images are obtained at six windows including pericardial-subcostal view, right flank hepatorenal angle (Morrison pouch), left flank splenorenal angle, supra pubic area, and anterior thoracic cavity on both the right and left side. The order in which images are obtained can vary but it is helpful to use a standardized approach for every patient to maximize the efficiency and accuracy of the examination.

Here we present the data of our E-fast study done in the emergency department in KMC hospital Trichy over 3 months, its correlation with CT Thorax and abdomen findings, and to validate the accuracy of E-fast in detecting blunt injury thorax and abdomen.

We studied the E-fast data in all trauma patients who received priority in 1 and 2 during triage. There were 117 patients and for 90 patients CT thorax and abdomen screening were done as per Advance Trauma Life Support protocol. Amongst 117 patients 18 patients were found to have E- fast positive. Thorax and abdominal CT have done were also found to have positive findings in all 18 of them, showing liver/splenic injury and haemopneumothorax. All other patients were closely observed for 48hrs for haemodyanamic instability and repeated Hb for drop in haemoglobin and were managed for their primary injury.

Results

Positive e fast findings:

Out of 117 patients, 18 patients were e fast positive; 5 had pneumothorax,4 had haemothorax, and 8 had blunt injury abdomen with splenic and liver laceration. One patient had diaphragmatic eventration, picked up only with CT abdomen.

Conclusion

Based on our findings E-fast correlated well with the CT findings. Thus, it’s a reliable simple tool that can be used in all major trauma centres.

In trauma first priority is given to stabilization, not imaging. In such cases, bedside E- fast is an easily accessible scan that has got high sensitivity and accuracy to CT abdomen.

E-fast helps to diagnose blunt injuries of the thorax and abdomen, thereby preventing the preventable deaths in the golden hour.