Can Extended Focused Assessment with Sonography for Trauma safely rule out critical injury? A prospective diagnostic accuracy study versus computed tomography in adult blunt trauma

Abstract Objective The objective of this study is to evaluate the diagnostic accuracy of Extended Focused Assessment with Sonography for Trauma (E‐FAST) performed by senior emergency medicine residents compared with computed tomography (CT) in patients with blunt thoracoabdominal trauma. Methods This prospective observational diagnostic accuracy study was conducted at a Level 1 trauma center between December 2023 and June 2024. Adult patients presenting with isolated blunt thoracoabdominal trauma who underwent both E‐FAST and thoracoabdominal CT were included. E‐FAST examinations were performed at the bedside by senior emergency medicine residents certified in ultrasonography. CT served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of E‐FAST were calculated. Concordance between E‐FAST and CT findings was analyzed using Fisher's exact test wherever appropriate. Results A total of 170 patients were analyzed (124 males [72.9%] and mean age: 38.2 ± 14.7 years). E‐FAST demonstrated a sensitivity of 100%, specificity of 98.7%, PPV of 88.2%, and NPV of 100% compared to CT. Concordance between E‐FAST and CT findings was statistically significant for intra‐abdominal free fluid, pneumothorax, and hemothorax ( p < 0.001 for each). No pericardial effusion was detected by either modality. Conclusion E‐FAST performed by adequately trained emergency medicine residents is a rapid, reliable, and highly accurate diagnostic tool in the initial evaluation of blunt thoracoabdominal trauma. Incorporating E‐FAST into standard trauma assessment protocols can enhance diagnostic efficiency and reduce unnecessary CT utilization.