EDITORIAL
FROM VALIDATION TO INTELLIGENT INTEGRATION: FAST AND eFAST ACROSS CONTEMPORARY EMERGENCY TRAUMA SYSTEMS

UDK: 616-001-083.98

Brzanov N.


1University Clinic for Traumatology, Orthopedic Disease, Anesthesiology, Reanimation and Intensive Care Medicine and Emergency Department, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, RN Macedonia

Brzanov Nikola  https://orcid.org/0000-0002-8518-5969

What Was Known: A Diagnostic Revolution

Focused Assessment with Sonography for Trauma (FAST) emerged in the 1990s as a transformative bedside innovation that redefined the tempo of trauma evaluation. By replacing diagnostic peritoneal lavage with a rapid, non-invasive ultrasonographic assessment, FAST shifted early trauma imaging from invasive confirmation toward immediate physiologic decision support. Its early validation established high specificity for clinically significant hemoperitoneum and reproducibility in hemodynamically unstable patients.

The subsequent evolution into extended FAST (eFAST), incorporating thoracic assessment for pneumothorax and hemothorax, expanded ultrasound into a multi-compartment resuscitative tool (1–3). Rather than pursuing anatomical completeness, eFAST aligns imaging with survival physiology, focusing on the detection of air or fluid as markers of life-threatening pathology. Performed concurrently with resuscitation, it preserves the primacy of airway, breathing, and circulation while enabling real-time decision-making. Its repeatability supports dynamic reassessment during evolving shock states, and in selected populations such as pregnancy, it provides radiation-free evaluation without compromising diagnostic immediacy (2).

Extended FAST (eFAST) is structured as a rapid bedside examination performed by the treating clinician during active resuscitation. By focusing on the detection of air and free fluid, it translates ultrasonography into immediate physiologic decision-making, particularly in hemodynamically unstable patients, where a positive examination may directly prompt surgical intervention. In contrast, in stable patients, computed tomography remains the gold standard for detailed evaluation of solid organ and retroperitoneal injury, while eFAST may serve as a triage or follow-up modality (2,6).

References:

  1. American College of Emergency Physicians. Ultrasound guidelines: emergency, point-of-care and clinical ultrasound guidelines in medicine. Ann Emerg Med. 2017;69:e27-e54.
  2. Testa, A.; Soldati, G.; Portale, G.; Pignataro, G.; Giannuzzi, R.; Silveri, N.G. EFAST: The evolution of FAST in polytrauma. Emerg.Care J. 2009, 5, 7.
  3. Bella FM, Bonfichi A, Esposito C, et al. Extended focused assessment with sonography for trauma in the emergency department: a comprehensive review. J Clin Med. 2025 ;14(10):3457. doi :10.3390/jcm14103457.
  4. Brzanov N, Brzanov AG, Kuzmanovska B, et al. Pioneering e-FAST in North Macedonia: A resource-efficient approach to polytrauma care (prospective cohort study). Scr Med. 2025 Nov-Dec;56(6):1095-106.
  5. Brzanov N, Trpeski S, Shosholcheva M, Jovchevski V, Srceva Jovanovski M, Gavrilovska Brzanov A. Fast guided initial triage of polytrauma patients: a prospective evaluation of diagnostic timelines.MJA 2025; IX(4):39-49.
  6. Kirkpatrick AW, Sirois M, Laupland KB, et al. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the extended focused assessment with sonography for trauma (EFAST). J Trauma. 2004; 57:288-295
  7. Salen, P.N.; Melanson, S.W.; Heller, M.B. The focused abdominal sonography for trauma (FAST) examination: Considerations and recommendations for training physicians in the use of a new clinical tool. Acad. Emerg. Med. 2000, 7, 162–168.
  8. Neri, L.; Storti, E.; Lichtenstein, D. Toward an ultrasound curriculum for critical care medicine. Crit. Care Med. 2007, 35, S290–S304.
  9. Rozycki GS, Ochsner MG, Jaffin JH, Champion HR. Prospective evaluation of surgeons’ use of ultrasound in the evaluation of trauma patients. J Trauma. 1993 Apr;34(4):516-26; discussion 526-7. doi: 10.1097/00005373-199304000-00008
  10. Brzanov N, Labacevski N, Antovik S, Trpevski S, OgnjenovicLj, Gavrilovska –Brzanov A. Implementation of focused assessment with ultrasonography in trauma patients in university surgical emergency department. MJA, 2023; vol 7(3): 77-83.
  11. Richards JR, McGahan JP. Focused assessment with sonography in trauma (FAST) in 2017: what radiologists can learn. Radiology. 2017;283(1):30-48. doi:10.1148/radiol.2017160107..
  12. Han DC, Rozycki GS, Schmidt JA, Feliciano DV. Ultrasound training during ATLS. J Trauma. 1996;41:208-213.
  13. World Health Organization. WHO essential diagnostics list: 3rd edition (2021). Geneva: World Health Organization; 2021.
  14. Meara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569–624. doi:10.1016/S0140-6736(15)60160-X.
  15. Sidhu PS, Cantisani V, Dietrich CF, et al. The EFSUMB guidelines and recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications: update 2017. Ultraschall Med. 2018 ;39(2) : e2-e44. doi :10.1055/a-0586-1107.
  16. Liu X, Faes L, Kale AU, Wagner SK, et al. A comparison of deep learning performance against health-care professionals in detecting diseases from medical imaging: a systematic review and meta-analysis. Lancet Digit Health. 2019 Oct;1(6):e271-e297. doi: 10.1016/S2589-7500(19)30123-2.
  17. Jiang, Z.; Salcudean, S.E.; Navab, N. Robotic ultrasound imaging: State-of-the-art and future perspectives. Med. Image Anal. 2023, 89, 102878.