Role of E-FAST in Assessing Suspected Trauma

Primary Functions of E-FAST in Trauma Assessment

E-FAST serves as a critical initial imaging tool compatible with ongoing resuscitation efforts when CT scanning is not immediately possible due to hemodynamic instability 1, 2
E-FAST allows rapid detection of free fluid in the peritoneal, pleural, and pericardial spaces, helping to identify the source of bleeding in trauma patients 3, 4
When combined with chest X-ray, E-FAST enables appropriate urgent intervention decisions with 98% accuracy in hemodynamically unstable patients 2

For intra-abdominal bleeding detection in pelvic trauma associated with severe abdominal trauma, E-FAST has a positive predictive value of 97% 2, 3
The negative predictive value of E-FAST is 97% in patients with shock, making it valuable for ruling out certain injuries 2, 3

When E-FAST and chest X-ray rule out extra-pelvic causes of hemorrhagic shock in pelvic trauma, patients should undergo body CT scan with intravenous contrast followed by angiography/embolization 2, 3
The abundance of hemoperitoneum detected on E-FAST correlates with the need for laparotomy - 3 positive E-FAST sites is associated with 61% appropriate laparotomies, while 2 positive sites correlates with 26% 2, 3
In rare cases of uncontrollable hemorrhagic shock, angiography/embolization can be performed immediately after E-FAST and chest X-ray to rule out non-pelvic massive hemorrhage 2, 3

In hemodynamically stable patients, E-FAST should be followed by a thoraco-abdomino-pelvic CT scan with contrast for complete injury assessment 5
In hemodynamically unstable patients, E-FAST combined with pelvic and chest X-rays may be the only imaging workup possible during ongoing resuscitation 2, 3

E-FAST performance may be diminished by false positives such as suffusion of a hemoretroperitoneum or intra-peritoneal bladder rupture 2, 3
E-FAST is not recommended as the primary tool for diagnosing duodeno-pancreatic trauma, though it is effective for detecting free fluid and solid organ injury 4

In pediatric patients and pregnant women, E-FAST can be used as an alternative to CT scan when hemodynamically stable, reducing radiation exposure 6
In children with mild symptoms, minimal clinical findings, and hematuria, ultrasound techniques including E-FAST may be adopted for initial evaluation 6

The European Society of Cardiology recommends traditional FAST as a focused, goal-directed sonographic examination to evaluate the pericardial space for hemopericardium and the peritoneal cavity for hemoperitoneum in trauma patients with signs of shock or suspected abdominal injury 7, 8
The primary goal of traditional FAST is to detect free fluid collection in body cavities to make rapid life-saving decisions, with a focus on the pericardial and peritoneal spaces 7, 8

The World Society of Emergency Surgery recommends EFAST, which expands the standard FAST by adding bilateral thoracic evaluation to detect hemothorax and pneumothorax, in addition to the traditional FAST findings 9, 10
EFAST includes all standard FAST views, as well as evaluation of the bilateral pleural spaces and lung parenchyma 9, 10

The American College of Surgeons recommends EFAST combined with chest X-ray for hemodynamically unstable patients, enabling appropriate urgent intervention decisions with high accuracy 9, 10
A negative EFAST does not rule out significant intra-abdominal injury requiring intervention, slowly accumulating free fluid if performed very early, or solid organ injuries without significant hemoperitoneum 10

The European Society of Emergency Medicine notes that EFAST has poor sensitivity for detecting pneumothorax in real-world trauma settings, though specificity remains high 9, 10
Retroperitoneal hemorrhage cannot be reliably detected by EFAST 9, 10