THE EFFECT OF BMI ON EFAST IN BLUNT TRAUMA PERFORMED BY SURGICAL RESIDENTS AT AN ACADEMIC LEVEL 1 TRAUMA CENTER

Objectives:

Objectives:
Trauma is the leading cause of death in the US among individuals younger than 45 and results in over 20 million ER visits every year. The eFAST is a non-invasive, rapid ultrasound-guided exam utilized in blunt trauma with specificity and sensitivity as high as 74% and 95%, respectively. One requirement for eFAST accuracy is the ability to obtain clear ultrasound views of the perihepatic, perisplenic, pelvic, and subxiphoid windows. Literature suggests that obesity is related to increased morbidity and mortality in trauma with obesity considered an independent risk factor for death following blunt trauma. Despite the increasing prevalence of obesity in the US, medical professionals may receive inadequate training/supervision on performance of eFAST in obese individuals. Previous studies have demonstrated that a BMI change from 36-40 changed the odds ratio (OR) for incorrect eFAST from 1.85 to 3.12.

Methods:
Prospective cohort series data collection on all blunt trauma patients at a Level I Academic trauma center from 5/13/22-8/18/22 who received both an eFAST and a CT and/or emergent exploratory thoracotomy/celiotomy. In our setting, most eFAST were done by residents with varying levels of attending supervision. There were 202 patients that met the inclusion criteria: 133 males:69 females. The median age of the patient population was 48 (range 6-93 yrs.) The median BMI was 27( range 13.29-62.95.) Accuracy was determined by the ability to detect fluid in any quadrant greater than a physiologic amount and/or recognize the absence of lung sliding or recognize a positive lung-point sign when compared to emergent CT scan results and/ or operating room findings.

Results:
The overall accuracy for eFAST was 85.64% with that of negative eFAST being 85% versus positive eFAST being 95% (See flow chart). Our data suggests that with every 1kg/m3 change in BMI the odds of accuracy decreased 5.6% (95% Cl 0.1% - 10.8%).

Conclusions:
Obesity continues to impose challenges on the healthcare system. With respect to this data, false negatives occur more frequently than false positives. Increasing BMI decreases the accuracy of eFAST exams. Considering the continued rise of obesity in America, simulation models for eFAST that encompass obesity variables and greater experience/supervision in obese patients may result in better accuracy, earlier identification and intervention for life-threatening injuries, and decreased mortality and morbidity.

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Results:

Conclusion: