Introduction Performing an Extended Focused Assessment with Sonography in Trauma (E-FAST) is a common practice in the initial assessment of trauma patients and it is often performed both in the extrahospital and intrahospital setting as the first diagnostic approach. It is demonstrated that E-FAST is a very useful tool to identify reversible causes of shock in traumatized patients but its utility in the pre-hospital setting remains unclear.

Objectives The aim of our study is to explore the diagnostic performance of the extra-hospital E-FAST, comparing it with the intra-hospital EFAST and CT-scan as a gold standard.

Material and methods We reviewed all major trauma patients accepted at the Trauma Center of Niguarda Hospital (Milan, Italy) from February 2021 to August 2023 who had undergone extrahospital e-FAST. The group included in our study was 151 patients, of which on 42 only intrahospital E-FAST was performed, while on the other 108, both intrahospital E-FAST and CT-scan were performed. Sensitivity, specificity, PPV (positive predictive value) and NPV (negative predictive value) were determined with 2-by-2 contingency tables. Inter-observer agreement was determined using absolute percentages of agreement and unweighted Cohen's kappa values.

Results The absolute percentage of agreement between EFAST extra and EFAST intra was 76.0 % (Κ = 0.41). The diagnostic performance of extra-hospital EFAST as a predictor for CT-scan was assessed. The results demonstrated a sensitivity of 42.5% and a specificity of 85.7%, while PPV and NPV were 86.1% and 41.7%, respectively; The accuracy was 56,5%.

Conclusions Extra hospital E-FAST showed a low level of overall reliability and shouldn"t be utilized as a sole diagnostic toll in trauma patients.

no