Retrospective Analysis of eFAST Exams to Detect COVID-19 in Trauma Patients

This original research study evaluates the utility of pulmonary point-of-care ultrasound (POCUS) within the extended focused assessment with sonography in trauma (eFAST) exam to detect asymptomatic COVID-19 in emergency department trauma patients. Specifically, it examines whether lung findings, such as B-lines, pleural thickening, and subpleural consolidations, can indicate a COVID-19 infection.

This retrospective review includes trauma patients aged 18 years or older who underwent eFAST and COVID-19 swab testing at the University of California, Irvine Medical Center, from December 2020 to October 2022. Two blinded reviewers analyzed eFAST scans for more than two B-lines, irregular pleural interface, or subpleural consolidations, with discrepancies resolved by ultrasound fellows. Sensitivity, specificity, and predictive values were calculated with 95% confidence intervals (CIs).

A total of 152 patients were included. Of 41 eFAST scans positive for COVID-19 findings, six were confirmed by PCR testing, yielding a positive predictive value of 15.6% (CI: 7.9%-25.6%). Among the 111 eFAST scans negative for COVID-19, 10 were PCR-positive, giving a negative predictive value of 91.0% (CI: 84.1%-95.6%). Sensitivity was 37.5% (CI: 15.2%-64.6%), and specificity was 74.3% (CI: 66.1%-81.4%).

Lung POCUS within the eFAST exam is not a reliable tool for detecting asymptomatic COVID-19 infection in trauma patients due to limited sensitivity and low positive predictive value. Standard diagnostic methods, such as PCR testing, and the use of personal protective equipment should remain the primary approach to protect healthcare providers.