The Combined Utility of EFAST and CXR in Blunt Thoracic Trauma

AbstractBackgroundPortable chest x-ray (CXR) and extended FAST (EFAST) screen patients for thoracic injury in the trauma bay. It is unclear if one test alone is sufficient, if both are required, or if the two investigations are complementary. Study objectives were to define the combined diagnostic yield of EFAST and CXR among stable blunt thoracic trauma patients and to determine if a normal EFAST and CXR might obviate the need for CT scan of the chest.MethodsAll blunt trauma patients ≥15 years presenting to LAC+USC Medical Center in 2016 were screened. Only patients who underwent CT Thorax were included. Patients were excluded if they presented >24h after injury, were transferred, or if they did not undergo EFAST and CXR. Demographics, physical exam (PEx) of the thorax, injury data, investigations, procedures, and outcomes were collected. EFAST, CXR, and PEx findings were compared to the gold standard CT Thorax to calculate the diagnostic yield of each investigation and combinations thereof in the assessment for clinically significant thoracic injury.Results1,311 patients met inclusion/exclusion criteria. Most common mechanisms of injury were motor vehicle collision (n=385, 29%) and auto vs pedestrian (AVP) (n=379, 29%). Mean ISS was 11 (1-75), with mean AIS Chest of 1.6 (1-6). The sensitivities of EFAST, CXR, and PEx, either individually or in combination, were 24h after injury, were transferred, or if they did not undergo EFAST and CXR. Demographics, physical exam (PEx) of the thorax, injury data, investigations, procedures, and outcomes were collected. EFAST, CXR, and PEx findings were compared to the gold standard CT Thorax to calculate the diagnostic yield of each investigation and combinations thereof in the assessment for clinically significant thoracic injury. Results 1,311 patients met inclusion/exclusion criteria. Most common mechanisms of injury were motor vehicle collision (n=385, 29%) and auto vs pedestrian (AVP) (n=379, 29%). Mean ISS was 11 (1-75), with mean AIS Chest of 1.6 (1-6). The sensitivities of EFAST, CXR, and PEx, either individually or in combination, were

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