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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 ultrasonography 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 eFAST was 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.
PMID
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Authors

Mayor MeshTerms

Hospitals, Urban

Trauma Centers

Keywords
Journal Title the american surgeon
Publication Year Start




PMID- 29580349
OWN - NLM
STAT- MEDLINE
DCOM- 20180404
LR  - 20180404
IS  - 1555-9823 (Electronic)
IS  - 0003-1348 (Linking)
VI  - 84
IP  - 2
DP  - 2018 Feb 1
TI  - eFAST for Pneumothorax: Real-Life Application in an Urban Level 1 Center by
      Trauma Team Members.
PG  - 220-224
AB  - 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 ultrasonography 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 eFAST was 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.
FAU - Maximus, Steven
AU  - Maximus S
FAU - Figueroa, Cesar
AU  - Figueroa C
FAU - Whealon, Matthew
AU  - Whealon M
FAU - Pham, Jacqueline
AU  - Pham J
FAU - Kuncir, Eric
AU  - Kuncir E
FAU - Barrios, Cristobal
AU  - Barrios C
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am Surg
JT  - The American surgeon
JID - 0370522
SB  - IM
MH  - *Hospitals, Urban
MH  - Humans
MH  - Pneumothorax/*diagnostic imaging/surgery
MH  - Retrospective Studies
MH  - Sensitivity and Specificity
MH  - Thoracostomy
MH  - Tomography, X-Ray Computed
MH  - *Trauma Centers
MH  - Ultrasonography
EDAT- 2018/03/28 06:00
MHDA- 2018/04/05 06:00
CRDT- 2018/03/28 06:00
PHST- 2018/03/28 06:00 [entrez]
PHST- 2018/03/28 06:00 [pubmed]
PHST- 2018/04/05 06:00 [medline]
PST - ppublish
SO  - Am Surg. 2018 Feb 1;84(2):220-224.