Diagnosis

Kirkpatrick AW
Hand-held Thoracic Sonography for Detecting Post-Traumatic Pneumothoraces: the Extended Focused Assessment with Sonography for Trauma (EFAST)
Journal of Trauma
August 2004; 288-295

Submitted by:Chad VanderLinden - Emergency Medicine Resident
Institution:Emergency Medicine Residency, Grand Rapids MERC/ Michigan State University
Date submitted:2nd March 2005

Before CA, i rated this paper: 8/10

1 Objectives and hypotheses

1.1 Are the objectives of the study clearly stated?

Yes, a prospective evaluation of the utility of adding a thoracic examination with hand-held sonography as an extension of the physical examination to detect PTXs during the initial resuscitation of injured patients.

2 Design

2.1 Is the study design suitable for the objectives

Yes

2.2 Who / what was studied?

Yes, injured patients at a provincial trauma referral center.

2.3 Was this the right sample to answer the objectives?

Yes

2.4 Is the study large enough to achieve its objectives? Have sample size estimates been performed?

Yes, No

2.5 Were all subjects accounted for?

No, only 416 of 436 lung fields were accounted for. 411 + 3 with chest tube + 2 with obvious subQ emphysema

2.6 Were all appropriate outcomes considered?

Yes

2.7 Has ethical approval been obtained if appropriate?

Yes, The study was approved by the thics and research committees of the U. of British Columbia, and the VHHSC.

2.8 Was an independent blinded gold standard test applied to all subjects?

No, doesn't mention if radiologists were blinded to EFAST results. Some positive results wiere confirmed by escape of air with drainage of PTX.

3 Measurement and observation

3.1 Is it clear what was measured, how it was measured and what the outcomes were?

Yes, Evidence of PTX, by EFAST, CXR, & CT. However outcomes were not clearly described.

3.2 Are the measurements valid?

Yes

3.3 Are the measurements reliable?

Yes

3.4 Are the measurements reproducible?

Unknown, Uncertain if accuracy of US performed by Trauma attendings is reproducible by others with varying degrees of US experience.

4 Presentation of results

4.1 Are the basic data adequately described?

Yes

4.2 Are the results presented clearly, objectively and in sufficient detail to enable readers to make their own judgement?

Graphs and/or tables with all results would have been helpful

4.3 Are the results internally consistent, i.e. do the numbers add up properly?

Yes

5 Analysis

5.1 Are the data suitable for analysis?

Yes

5.2 Are the methods appropriate to the data?

Yes

5.3 Are any statistics correctly performed and interpreted?

Yes

6 Discussion

6.1 Are the results discussed in relation to existing knowledge on the subject and study objectives?

Yes

6.2 Is the discussion biased?

7 Interpretation

7.1 Are the authors' conclusions justified by the data?

Yes

7.2 What level of evidence has this paper presented? (using CEBM levels )

7.3 Does this paper help me answer my problem?

Yes, neither CXR or EFAST are sensitive exams for the detection of PTX

After CA, i rated this paper: 5/10

8 Implementation

8.1 Can the test be implemented in practice?

Yes

8.2 What aids to implementation exist?

No additional equipment & little extra time would be necessary

8.3 What barriers to implementation exist?

None

8.4 Are my patients the same as the patients tested?

Yes

8.5 Will the test improve diagnosis in my patients?

Yes, EFAST increases identification of PTX while in the trauma bay & doesn't increase false positive detection by any appreciable degree.