Comparison of Diagnostic Accuracy of Extended Focused Assessment of Sonography in Trauma (eFAST) With Clinical Examination and Chest X-ray in Detecting Hemo/Pneumothorax for Blunt Chest Trauma

Background Blunt chest trauma represents a significant cause of preventable mortality globally, accounting for approximately one-third of trauma-related deaths in India. Timely diagnosis of hemothorax and pneumothorax is essential to prevent clinical deterioration. While clinical examination and chest X-ray (CXR) are commonly employed, their diagnostic sensitivity is limited. The extended focused assessment with sonography in trauma (eFAST) offers a rapid, bedside, radiation-free alternative with demonstrated diagnostic utility. Objective The objective of this study was to evaluate and compare the diagnostic accuracy of eFAST, clinical examination, and CXR for the detection of hemothorax and pneumothorax, with CT chest serving as the reference standard. Methods This prospective diagnostic observational study was conducted at the Department of General Surgery, Pondicherry Institute of Medical Sciences, India, between January 2021 and June 2022. Eighty-one hemodynamically stable patients with blunt chest trauma underwent clinical examination, CXR, eFAST, and CT chest evaluation. Diagnostic performance metrics, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy, were calculated with CT chest as the gold standard. Results The mean age was 49.2 ± 15.6 years, with 71.6% of participants being male. Road traffic accidents were the predominant mechanism (67.9%). CT chest revealed thoracic injuries in 64.2% of cases. Clinical examination showed a sensitivity of 34.6% and specificity of 100%. Chest X-ray had a sensitivity of 76.9%, a specificity of 85.2%, and an accuracy of 81.5%. eFAST achieved a sensitivity of 98.1%, specificity of 98.8%, PPV of 98%, NPV of 96.7%, and an overall accuracy of 98.5%. Conclusion eFAST demonstrated superior diagnostic accuracy compared to clinical examination and CXR, and closely approximated the diagnostic reliability of CT chest. Given its portability, absence of radiation, and rapid application, eFAST should be integrated as a frontline tool in the evaluation of blunt chest trauma.