Andrews J1,2,3, George N1,2, Noon L1, Azzopardi M2, Vidler S1,2
1Hunter Retrieval Service, 2Department of Emergency Medicine, John Hunter Hospital, 3School of Medicine and Public Health, University of Newcastle
Biography:
Jake Andrews is a Newcastle-based emergency medicine specialist and retrieval consultant. He received his medical degree from The Peninsula College of Medicine and Dentistry, before making the move to sunny Australia where he’s spent the last 8 years. He completed his training in emergency medicine/retrieval/ultrasound medicine in the Hunter, obtaining his FACEM, APHRM, and CCPU along the way. He’s currently a staff specialist at John Hunter Hospital and the Calvary Mater Newcastle, and a retrieval consultant with RFDS in Mount Isa, QLD. In his free time he enjoys spending time with his growing family and cleaning ultrasound machines.
Abstract
AIMS: Extended Focused Assessment with Sonography for Trauma (eFAST) is well-established for the in-hospital evaluation of injured patients. Early data indicate eFAST may improve prehospital clinical decision-making and reduce time to definitive intervention. However, few studies evaluate complete exams and reported accuracy figures vary widely.
METHODS: We completed a retrospective review of all patients assessed by a single retrieval service over a three-year period. All prehospital trauma patients with a complete eFAST and paired in-hospital imaging/operative findings were included in the primary analysis. Inconclusive studies and cases with chest decompression prior to eFAST were excluded. The primary outcome of interest was diagnostic accuracy. We also performed a multivariable logistic regression to evaluate the impact of clinical/operational factors including: age, sex, body mass index (BMI), physician specialty/level, year, and mechanism.
RESULTS: 1,020 prehospital cases were identified with 214 eFAST scans eligible for primary analysis. Most patients were young (median age 32.5 years), male (77.6%), and suffered blunt trauma (94.4%). Sensitivity and specificity were 52.5% and 96.6%, respectively, with a negative predictive value of 89.8% and a positive predictive value of 77.8%. Multivariable analysis of 121 cases with complete patient and operational data found higher accuracy among registrar scans (OR 3.12 [95% CI 1.01-9.64]).
CONCLUSIONS: In our analysis of 214 prehospital eFAST exams performed by retrieval physicians, we found a modest sensitivity with a high specificity. These data add important and new context to previously published figures as they represent the outcomes of complete six-view eFAST scans matched with confirmatory in-hospital findings.