Extended focused assessment with sonography for trauma among blunt torso injury patients at Mulago Hospital

Abstract

Introduction: Evaluation of patients with torso trauma is often a diagnostic challenge for emergency physicians and trauma surgeons. This is mainly because of large cavities in this part of the body which may theoretically harbor up to whole of intravascular volume and/or air in case of injury to the thorax causing tension pneumothorax reflecting the importance of reaching to a diagnosis and offer life saving management as fast as possible. Focused assessment with sonography for trauma (FAST) is a trauma emergence ultrasound scan that is used to evaluate for presence of fluid accumulation in the abdominal cavity and the pericardium. EFAST is an emergency ultrasound scan which adds the evaluation of thoracic structures for hemothorax and pneumothorax in addition to evaluation of abdominal cavity and pericardium done in FAST. Following EFAST patients may either undergo surgery or managed nonoperatively. Mulago hospital receives an average of 1500 trauma patients per month, about 300 being patients suspected to have torso injury (internal injury of the trunk) and about 20 patients with real torso injury. Objective: The study aimed at describing the pattern of EFAST findings, to evaluate EFAST tool in quicker patient assessment and the immediate outcome of the patients following torso trauma at Mulago A&E. Methods: This was a crossectional descriptive study done at Mulago hospital A&E from January to April 2012. A total of 197 patients suspected to have torso injury were recruited conveniently. Patients with penetrating torso injuries were excluded. Eligible patients underwent EFAST scan and then were allowed to continue with management according to the A&E management protocol which involves Chest X ray or full abdominal ultrasound scan depending on the patients’ complaints. A&E management protocol diagnoses were compared to the EFAST diagnoses by calculating sensitivity, specificity as well as negative and positive predictive values. Ethical consideration was adhered to. Duration taken for diagnosis to be reached was also documented for EFAST and A&E management protocol. Results: In this study a total of 197 patients were recruited. Of these patients 165 (83.76%) were males and 32 (16.24%) were females. Mean age was 26.8 with standard deviation of 10.8. The pattern of EFAST was very comparable to A&E management protocol findings. The sensitivity of EFAST was 100% and specificity of 96.62%. The positive predictive value was 87.18% and negative predictive value was 100%. Duration for performing EFAST was averaging 5 minutes and it was being done during patient resuscitation before secondary survey. One sixty eight (85.28%) patients were EFAST scanned within an hour from admission while most of the patients 105 (53.30%) were diagnosed according to standard of care after an hour of stay at the hospital. Most patients 82 (48%) were discharged on the same day of hospitalization. By the end of the first week 151 (76.7%) patients had been discharged while 13 (6.6%) patients were discharged in the second week and 7 (3.6%) were still at the hospital by the end of two weeks. Eight patients were lost to follow up. Mortality occurred among 18 (9.1%). Conclusion: EFAST is a fast and reliable method for assessment of torso trauma patients as compared to A&E management protocol, namely full abdominal ultrasound and chest X ray at MNRH A&E unit.