Use of hand-held ultrasound to perform E-FAST by general surgery residents in a trauma reference center: First experience in the Colombian Caribbean region
DOI:
https://doi.org/10.30944/20117582.2390Palabras clave:
ultrasonografía, computadoras de mano, heridas y traumatismos, medicina de emergencia, economía hospitalaria, educación de postgrado en medicinaResumen
Introduction. Extended focused assessment with sonography for trauma (E-FAST) can be performed with minimal training and achieve ideal results. It allows easy transport and use in austere environments such as the Colombian Caribbean, where many centers do not have 24-hour radiology services. The objective of this study was to determine the performance of the use of E-FAST in the evaluation of trauma by second-year general surgery residents in the emergency department.
Methods. Retrospective observational study that evaluated the diagnostic performance of E-FAST with Butterfly IQ, in patients with thoracoabdominal trauma, who attended a referral center in the Colombian Caribbean between November 2021 and July 2022. Sensitivity, specificity, and positive and negative predictive values were evaluated, compared with intraoperative findings or conventional imaging.
Results. A total of 46 patients were included, with a mean age of 31.2 ± 13.8 years, 87.4% (n=39) were male. The main mechanism of trauma was penetrating (n=32; 69.5%). It was found that 80.4% (n=37) of the patients had a positive E-FAST result, and of these, 97% (n=35) had a positive intraoperative finding. Sensitivity, specificity, positive predictive value and negative predictive value were 92.1%, 75%, 94.6%, and 66.6%, respectively. The positive likelihood ratio was 3.68, while the negative likelihood ratio was 0.10.
Conclusion. General surgery residents have the competence to perform accurate E-FAST scans. The hand-held ultrasound device is an effective diagnostic tool for trauma and acute care surgery patients.
Descargas
Referencias bibliográficas
Corcoran F, Bystrzycki A, Masud S, Mazur SM, Wise D, Harris T. Ultrasound in pre-hospital trauma care. Trauma. 2016;18:101-10. https://doi.org/10.1177/1460408615606753
Rozycki GS, Feliciano DV, Schmidt JA, Cushman JG, Sisley AC, Ingram W, Ansley JD. The role of surgeon-performed ultrasound in patients with possible cardiac wounds. Ann Surg. 1996;223:737-46. https://doi.org/10.1097/00000658-199606000-00012
Lentz B, Fong T, Rhyne R, Risko N. A systematic review of the cost-effectiveness of ultrasound in emergency care settings. Ultrasound J. 2021;13:16. https://doi.org/10.1186/s13089-021-00216-8
Kirkpatrick AW, Sirois M, Laupland KB, Liu D, Rowan K, Ball CG, et al. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: The Extended Focused Assessment with Sonography for Trauma (EFAST). J Trauma. 2004;57:288-95. https://doi.org/10.1097/01.TA.0000133565.88871.E4
Baribeau Y, Sharkey A, Chaudhary O, Krumm S, Fatima H, Mahmood F, Matyal R. Handheld Point-of-Care Ultrasound probes: The new generation of POCUS. J Cardiothorac Vasc Anesth. 2020;34:3139-45. https://doi.org/10.1053/j.jvca.2020.07.004
Brooks A, Davies B, Smethhurst M, Connolly J. Prospective evaluation of non-radiologist performed emergency abdominal ultrasound for haemoperitoneum. Emerg Med J. 2004;21:e5. https://doi.org/10.1136/emj.2003.006932
Arbelaez C, Patiño A. State of emergency medicine in Colombia. Int J Emerg Med. 2015;8:9. https://doi.org/10.1186/s12245-015-0057-4
Rutten MH, Giesen PHJ, Assendelft WJJ, Westert G, Smits M. Effects of access to radiology in out-of-hours primary care on patient satisfaction and length of stay. Eur J Gen Pract. 2021;27:221-7. https://doi.org/10.1080/13814788.2021.1959911
Dean AG, Sullivan KM, Soe MM. OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version. www.OpenEpi.com, updated 2013/04/06. Fecha de consulta: 13 de marzo de 2023. Disponible en: http://www.openepi.com./Menu/OE_Menu.htm
Netherton S, Milenkovic V, Taylor M, Davis PJ. Diagnostic accuracy of eFAST in the trauma patient: a systematic review and meta-analysis. CJEM. 2019;21:727-38. https://doi.org/10.1017/cem.2019.381
Kotagal M, Quiroga E, Ruffatto BJ, Adedipe AA, Backlund BH, Nathan R, et al. Impact of point-of-care ultrasound training on surgical residents’ confidence. J Surg Educ. 2015;72:e82-7. https://doi.org/10.1016/j.jsurg.2015.01.021
Nassour I, Spalding MC, Hynan LS, Gardner AK, Williams BH. The surgeon-performed ultrasound: a curriculum to improve residents’ basic ultrasound knowledge. J Surg Res. 2017;213:51-9. https://doi.org/10.1016/j.jss.2017.02.031
Dammers D, El Moumni M, Hoogland II, Veeger N, ter Avest E. Should we perform a FAST exam in haemodynamically stable patients presenting after blunt abdominal injury: a retrospective cohort study. Scand J Trauma Resusc Emerg Med. 2017 Dec 3;25(1):1. https://doi.org/10.1186/s13049-016-0342-0
Uribe FL, Carvajal SM, Torres NF, Bustamante LA, García AF. Equipos de trauma: Realidad mundial e implementación en un país en desarrollo. Descripción narrativa. Rev Colomb Cir. 2021;36:42-50. https://doi.org/10.30944/20117582.650
Elbaih AH, Abu-Elela ST. Predictive value of focused assessment with sonography for trauma (FAST) for laparotomy in unstable polytrauma Egyptians patients. Chin J Traumatol. 2017;20:323-8. https://doi.org/10.1016/j.cjtee.2017.09.001
Giraldo-Restrepo JA, Serna-Jiménez TJ. Examen FAST y FAST extendido. Rev Colomb Anest. 2015;43:299-306. https://doi.org/10.1016/j.rca.2015.03.010
Stengel D, Leisterer J, Ferrada P, Ekkernkamp A, Mutze S, Hoenning A. Point-of-care ultrasonography for diagnosing thoracoabdominal injuries in patients with blunt trauma. Cochrane Database Syst Rev. 2018;12:CD012669. https://doi.org/10.1002/14651858.CD012669.pub2
Hsu SD, Chen CJ, Chan DC, Yu JC. Senior general surgery residents can be trained to perform focused assessment with sonography for trauma patients accurately. Surg Today. 2017;47:1443-9. https://doi.org/10.1007/s00595-017-1535-5
Stengel D, Rademacher G, Ekkernkamp A, Güthoff C, Mutze S. Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma. Cochrane Database Syst Rev. 2015;9:CD004446. https://doi.org/10.1002/14651858.CD004446.pub4
Kim TA, Kwon J, Kang BH. Accuracy of Focused Assessment with Sonography for Trauma (FAST) in blunt abdominal trauma. Emerg Med Int. 2022;2022:8290339. https://doi.org/10.1155/2022/8290339

Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2023 Revista Colombiana de Cirugía

Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
Todos los textos incluidos en la Revista Colombiana de Cirugía están protegidos por derechos de autor. Las opiniones expresadas en los artículos firmados son las de los autores y no coinciden necesariamente con las de los directores o los editores de la Revista Colombiana de Cirugía. Las sugerencias diagnósticas o terapéuticas como elección de productos, dosificación y métodos de empleo corresponden a la experiencia y al criterio de los autores.