Surgical Resident Education and Performance in Extended Focused Abdominal Sonography for Trauma.

Extended focused assessment with sonography for trauma (eFAST) is a rapid triage tool aiding the detection of life-threatening injuries. In academic settings, residents perform most eFAST; however, the ACGME has no recommendations for eFAST training standards. We surveyed general surgery programs (GSPs) regarding eFAST training and established a baseline for sensitivity, specificity, and positive and negative predictive values for resident-performed eFAST. US GSP eFAST surveys were conducted by email and phone. We prospectively collected patient variables and evaluated resident performance from May to September 2022 and 2023 at an academic level I trauma center. A total of 60/339 general surgery residency programs (GSRPs) responded: Ten use Advanced Trauma Life Support (ATLS) only, n = 7 group training, n = 8 on-the-job only, and n = 33 several methods. Resident-performed eFAST had accuracy = 85.6%, sensitivity = 35.6%, specificity = 97.2%, PPV = 75%, and NPV = 87%. General surgery residency program training in eFAST is non-standardized. Sensitivity was considerably lower than the literature suggests. Positive resident-performed eFAST is generally accurate. We recommend a standardized approach to resident training in eFAST.

The Effect of BMI on eFAST Accuracy in Trauma by Residents in the Emergency Room.

Blunt trauma patients are often evaluated with extended focused assessment with sonography for trauma (eFAST). eFAST is a noninvasive, rapid, ultrasound-guided assessment for hemoperitoneum, pericardial effusion, and hemopneumothorax. Specificity and sensitivity are as high as 95% and 74%, respectively. Research suggests obesity confers increased morbidity and mortality and is an independent risk factor for trauma death. A previous study demonstrated that a BMI change from 36 to 40 changed the odds ratio for inaccurate eFAST from 1.85 to 3.12. Our current prospective data collection is 202 consecutive blunt trauma patients from 5/13/22 to 8/18/22 receiving an eFAST and a CT/OR for comparison. Odds ratio of inaccurate eFAST increased by 5.65% for each increase of 1 kg/m3 of BMI (95% Cl 0.1%-10.8%). This research also investigated surgical resident eFAST accuracy to improve patient outcomes through the implementation of individualized training in normal and obese models.