title: Utility of extended FAST in blunt chest trauma: is it the time to be used in the ATLS algorithm?
abstract: BACKGROUND
  The clinical significance of extended Focused Assessment with Sonography for Trauma (EFAST) for diagnosis of pneumothorax is not well defined.
  
  
  OBJECTIVE
  To investigate the utility of EFAST in blunt chest trauma (BCT) patients.
  
  
  METHODS
  A single blinded, prospective study.
  
  
  METHODS
  All patients admitted with BCT (2011-2013).
  
  
  METHODS
  Level 1 trauma center in Qatar.
  Patients were screened by EFAST and results were compared to the clinical examination (CE) and chest X-ray (CXR). Chest-computed tomography (CT) scoring system was used to confirm and measure the pneumothorax. Diagnostic accuracy of diagnostic modalities of pneumothorax was measured using sensitivity, specificity, predictive values (PVs), and likelihood ratio.
  
  
  RESULTS
  A total of 305 BCT patients were included with median age of 34 (18-75). Chest CT was positive for pneumothorax in 75 (24.6 %) cases; of which 11 % had bilateral pneumothorax. Chest CT confirmed the diagnosis of pneumothorax in 43, 41, and 11 % of those who were initially diagnosed by EFAST, CE, and CXR, respectively. EFAST was positive in 42 hemithoraces and its sensitivity (43 %) was higher in comparison to CXR (11 %). Positive and negative PVs of EFAST were 76 and 92 %, respectively. The frequency of missed cases by CXR was higher in comparison to EFAST and CE. The lowest median score of missed pneumothorax was observed by EFAST.
  
  
  CONCLUSIONS
  EFAST can be used as an efficient triaging tool in BCT patients to rule out pneumothorax. Based on our analysis, we would recommend EFAST as an adjunct in ATLS algorithm.
authors.affiliation: Trauma Surgery Section, Hamad General Hospital (HGH), P.O Box 3050, Doha, Qatar, traumaresearch@hmc.org.qa.
authors.forename: Yassir
authors.initials: Y
authors.lastname: Abdulrahman
authors.forename: Shameel
authors.initials: S
authors.lastname: Musthafa
authors.forename: Suhail Y
authors.initials: SY
authors.lastname: Hakim
authors.forename: Syed
authors.initials: S
authors.lastname: Nabir
authors.forename: Ahad
authors.initials: A
authors.lastname: Qanbar
authors.forename: Ismail
authors.initials: I
authors.lastname: Mahmood
authors.forename: Tariq
authors.initials: T
authors.lastname: Siddiqui
authors.forename: Wafaa A
authors.initials: WA
authors.lastname: Hussein
authors.forename: Hazim H
authors.initials: HH
authors.lastname: Ali
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Afifi
authors.forename: Ayman
authors.initials: A
authors.lastname: El-Menyar
authors.forename: Hassan
authors.initials: H
authors.lastname: Al-Thani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011030:Pneumothorax / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*; D055815:Young Adult