Diagnostic Utility of Extended Focused Assessment With Sonography in Trauma (eFAST) in Hemodynamically Stable Patients With Blunt Thoracoabdominal Injury: A Prospective Study

Background Extended focused assessment with sonography in trauma (eFAST) has become an important component of trauma evaluation for rapid bedside detection of thoracic and intra-abdominal injuries. Although its role in hemodynamically unstable trauma is well established, prospective evidence evaluating its diagnostic value in hemodynamically stable patients with blunt thoracoabdominal trauma remains limited. This study aimed to assess the diagnostic utility of eFAST in stable blunt trauma patients by examining its concordance with final hospital discharge diagnosis and comparing its detection performance with chest radiography for thoracic injuries. Methods A prospective observational study was conducted on 120 hemodynamically stable patients presenting with blunt thoracic and/or abdominal trauma between August 2022 and March 2024. All patients underwent standardized clinical assessment, chest radiography, and bedside eFAST examination. Final hospital discharge diagnosis, incorporating operative findings, intercostal chest tube findings, and clinical course with follow-up imaging when indicated, served as the composite reference standard. Diagnostic performance of ultrasound for thoracic and abdominal injuries was evaluated, and detection rates were compared with chest radiography. Results Among the 120 patients included in the study, 78 had thoracic injuries, and 48 had intra-abdominal injuries based on final hospital diagnosis. eFAST detected 68 of 78 thoracic injuries, yielding a sensitivity of 87.2% (95% CI 77.9-93.4) and specificity of 100% (95% CI 91.6-100). For abdominal injuries, ultrasound detected 46 of 48 cases, corresponding to a sensitivity of 95.8% (95% CI 85.7-99.5) and specificity of 100% (95% CI 94.9-100). Chest radiography identified 32 of 78 thoracic injuries (41.0%). The difference in detection between ultrasound and chest radiography was statistically significant (p < 0.001). Ultrasound findings also demonstrated a strong correlation with subsequent management decisions, as all patients requiring intercostal chest tube insertion or exploratory laparotomy had positive ultrasound findings. Conclusions eFAST is a reliable and effective bedside imaging modality for evaluating hemodynamically stable patients with blunt thoracoabdominal trauma. It demonstrates high diagnostic accuracy for both thoracic and abdominal injuries and significantly outperforms chest radiography in detecting thoracic trauma. Its strong correlation with management decisions further supports the role of eFAST as a valuable triage adjunct in trauma care, particularly in resource-limited settings.