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Original articles
Detection of pneumothoraces in patients with multiple blunt trauma: use and limitations of eFAST
  1. Thomas C Sauter,
  2. Simon Hoess,
  3. Beat Lehmann,
  4. Aristomenis K Exadaktylos,
  5. Dominik G Haider
  1. Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
  1. Correspondence to Thomas C Sauter, Department of Emergency Medicine, Inselspital, Bern University Hospital, Freiburgstrasse, Bern 3010, Switzerland; Thomas.Sauter{at}insel.ch

Abstract

Background Extended focused assessment with sonography for trauma (eFAST) has been shown to have moderate sensitivity for detection of pneumothorax in trauma. Little is known about the location or size of missed pneumothoraces or clinical predictors of pneumothoraces in patients with false-negative eFAST.

Methods This retrospective cross-sectional study includes all patients with multiple blunt trauma diagnosed with pneumothorax who underwent both eFAST and CT performed in the ED of a level 1 trauma centre in Switzerland between 1 June 2012 and 30 September 2014. Sensitivity of eFAST for pneumothorax was determined using CT as the gold standard. Demographic and clinical characteristics of those who had a pneumothorax detected by eFAST and those who did not were compared using the Mann-Whitney U or Pearson’s χ2 tests. Univariate binary logistic regression models were used to identify predictors for pneumothoraces in patients with negative eFAST examination.

Results The study included 109 patients. Overall sensitivity for pneumothorax on eFAST was 0.59 and 0.81 for pneumothoraces requiring treatment. Compared with those detected by eFAST, missed pneumothoraces were less likely to be ventral (30 (47.6%) vs 4 (9.3%), p <0.001) and more likely to be apical and basal (7 (11.1%) vs 15 (34.9%), p=0.003; 11 (17.5%) vs 18 (41.9%), p=0.008, respectively). The missed pneumothoraces were smaller than the detected pneumothoraces (left side: 30.7±17.4 vs 12.1±13.9 mm; right side: 30.2±10.1 vs 6.9±10.2 mm, both p <0.001). No clinical variables were identified which predicted pneumothoraces in falsely negative eFAST. Among those pneumothoraces missed by eFAST, 30% required tube thoracostomy compared with 88.9% of those detected with eFAST.

Conclusion In our study, pneumothoraces missed by eFAST were smaller and in atypical locations compared with those detected by eFAST and needed thoracic drainage less often.

  • blunt trauma
  • eFAST
  • multiple trauma
  • pneumothorax
  • trauma room

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/emermed-2016-205980

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    Footnotes

    • Preliminary results of this study have been presented at the 28th Euroson Congress of the EFSUMB, Leipzig, Germany.

    • Contributors All authors significantly contributed to the final manuscript in its present form, including conception and design of the study, drafting of the manuscript and final approval of the manuscript.

    • Competing interests None declared.

    • Patient consent No informed consent is necessary according to the Ethics Committee, because of the retrospective design and the handling of anonymised data.

    • Ethics approval The study protocol was approved and registered by the Ethics Committee of Canton Bern, Switzerland (number 155/2015).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All presented data can be obtained from the corresponding author.