Effect of the Extended Focused Assessment With Sonography for Trauma on the Screening Performance of the National Emergency X-Radiography Utilization Study Chest Decision Instrument.

Autor: Grade MM; Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA. Electronic address: madeline.grade@ucsf.edu., Ehlers PF; Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA., Kornblith AE; Department of Emergency Medicine and Department of Pediatrics, University of California, San Francisco, San Francisco, CA., Mower WR; Department of Emergency Medicine, University of California, Los Angeles, Los Angeles, CA., Raja AS; Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Schleifer J; Department of Anesthesia, Critical Care and Emergency Medicine, University Hospital Bonn, Bonn, Germany., Liteplo A; Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA., Rodriguez RM; Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA.
Jazyk: angličtina
Zdroj: Annals of emergency medicine [Ann Emerg Med] 2023 Apr; Vol. 81 (4), pp. 495-500. Date of Electronic Publication: 2023 Feb 07.
DOI: 10.1016/j.annemergmed.2022.09.027
Abstrakt: Study Objective: Developed to decrease unnecessary thoracic computed tomography use in adult blunt trauma patients, the National Emergency X-Radiography Utilization Study (NEXUS) Chest clinical decision instrument does not include the extended Focused Assessment with Sonography in Trauma (eFAST). We assessed whether eFAST improves the NEXUS Chest clinical decision instrument's diagnostic performance and may replace the chest radiograph (CXR) as a predictor variable.
Methods: We performed a secondary analysis of prospective data from 8 Level I trauma centers from 2011-2014. We compared performance of modified clinical decision instruments that (1) added eFAST as a predictor (eFAST-added clinical decision instrument), and (2) replaced CXR with eFAST (eFAST-replaced clinical decision instrument), in screening for blunt thoracic injuries.
Results: One thousand nine hundred fifty-seven patients had documented computed tomography, CXR, clinical NEXUS criteria, and adequate eFAST; 624 (31.9%) patients had blunt thoracic injuries, and 126 (6.4%) had major injuries. Compared to the NEXUS Chest clinical decision instrument, the eFAST-added clinical decision instrument demonstrated unchanged screening performance for major injury (sensitivity 0.98 [0.94 to 1.00], specificity 0.28 [0.26 to 0.30]) or any injury (sensitivity 0.97 [0.95 to 0.98], specificity 0.21 [0.19 to 0.23]). The eFAST-replaced clinical decision instrument demonstrated unchanged sensitivity for major injury (sensitivity 0.93 [0.87 to 0.97], specificity 0.31 [0.29 to 0.34]) and decreased sensitivity for any injury (0.93 [0.91 to 0.951] versus 0.97 [0.953 to 0.98]).
Conclusion: In our secondary analysis, adding eFAST as a predictor variable did not improve the diagnostic screening performance of the original NEXUS Chest clinical decision instrument; eFAST cannot replace the CXR criterion of the NEXUS Chest clinical decision instrument.
(Copyright © 2022 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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