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A multicenter evaluation of the accuracy of prehospital eFAST by a physician-staffed helicopter emergency medical service

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Abstract

Purpose

The purpose of this study is to report the relative accuracy of prehospital extended focused assessment with sonography in trauma (eFAST) examinations performed by HEMS physicians.

Methods

Trauma patients who received prehospital eFAST by HEMS clinicians between January 2013 and December 2017 were reviewed. The clinician’s interpretations of these ultrasounds were compared to gold standard references of CT imaging or operating room findings. The outcomes measured include the calculated accuracy of eFAST for detecting intraperitoneal free fluid (IPFF), pneumothorax, hemothorax, and pericardial fluid compared to available gold standard results.

Results

Of the 411 patients with adequate data for comparison, the median age was 39.5 years with 73% male and 98% sustaining blunt force trauma. For the detection of IPFF, eFAST had a sensitivity of 25% (95% CI 16–36%) and specificity of 96% (95% CI 93–98%). Sensitivities and specificities were calculated for pneumothorax (38% and 96% respectively), hemothorax (17% and 97% respectively), and pericardial effusion (17% and 100% respectively). These results did not change significantly when reassessed with several sensitivity analyses.

Conclusion

Prehospital eFAST is reliable for detecting the presence of intraperitoneal free fluid. This finding should inform receiving trauma teams to prepare for early definitive care in these patients. The low sensitivities across all components of the eFAST highlight the importance of cautiously interpreting negative studies while prompting the need for further studies.

Trial registration

ACTRN12618001973202 (Registered on 06/12/2018).

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Data availability

Via email to the corresponding author.

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Acknowledgements

We acknowledge Sandra Ware (Research Manager, Aeromedical Operations, NSW Ambulance) and Kait Luker (Database Administrator, Aeromedical Operations, NSW Ambulance) for their work on collating the data set as well as Linda Gutierrez (Trauma Department, Westmead Hospital), Nimmi Kumar and Sally Forrest-Horder (Trauma Department, Liverpool Hospital) for providing access to their local trauma data sets.

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Authors and Affiliations

  1. Aeromedical Operations, NSW Ambulance, 33 Nancy Ellis Leebold Drive, Bankstown Airport, Sydney, NSW, 2200, Australia

    Christopher Partyka, Jimmy Bliss & Matthew Miller

  2. Emergency Department, Liverpool Hospital, Liverpool, NSW, Australia

    Christopher Partyka & Jimmy Bliss

  3. South Western Sydney Clinical School, University of New South Wales, Kensington, Australia

    Christopher Partyka

  4. Emergency Department, Westmead Hospital, Westmead, NSW, Australia

    Andrew Coggins

  5. Western Clinical School, University of Sydney, Sydney, Australia

    Andrew Coggins

  6. Sydney Medical School, University of Sydney, Sydney, Australia

    Jimmy Bliss & Brian Burns

  7. GSA-HEMS, NSW Ambulance, Blacktown, NSW, Australia

    Brian Burns

  8. Emergency Department, Blacktown Hospital, Blacktown, NSW, Australia

    Michele Fiorentino

  9. Intensive Care Unit, Liverpool Hospital, Liverpool, NSW, Australia

    Pierre Goorkiz

  10. School of Medicine, Western Sydney University, Sydney, Australia

    Pierre Goorkiz

  11. UNSW St George and Sutherland Clinical Schools, Kogarah, Australia

    Matthew Miller

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  1. Christopher Partyka
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Correspondence to Christopher Partyka.

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Prospective ethical approval was obtained by local human research ethics committee (LNR/18/POWH/262).

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Partyka, C., Coggins, A., Bliss, J. et al. A multicenter evaluation of the accuracy of prehospital eFAST by a physician-staffed helicopter emergency medical service. Emerg Radiol 29, 299–306 (2022). https://doi.org/10.1007/s10140-021-02002-4

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  • DOI: https://doi.org/10.1007/s10140-021-02002-4

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