e²FAST: Integrating Inferior Vena Cava Ultrasound Into the Extended Focused Assessment With Sonography for Trauma as a Rapid Diagnostic Tool of Hemorrhagic Shock in Trauma Patients
Bibliographic record
Abstract
Hemorrhagic shock remains a leading cause of preventable trauma-related deaths, highlighting the need for rapid and accurate diagnosis. This study evaluates whether integrating inferior vena cava ultrasound (IVC-US) into the extended focused assessment with Sonography for trauma (eFAST), referred to as "e²FAST," improves early shock detection and guides fluid resuscitation in trauma patients. A comprehensive narrative review was conducted to assess the diagnostic and prognostic value of IVC-US as a rapid diagnostic tool for hemorrhagic shock in trauma patients. Studies published from 2000 to January 2025 were searched across PubMed, MEDLINE, EMBASE, Cochrane Library, and Scopus databases. Studies were included if they involved adult trauma patients and evaluated IVC diameter or the collapsibility index (IVC-CI) to determine volume status, shock, or fluid responsiveness. Two independent reviewers screened and selected studies based on predefined inclusion criteria. In total, 13 eligible studies, including randomized controlled trials, prospective and retrospective cohorts, and cross-sectional analyses, were reviewed qualitatively. Key outcomes extracted included diagnostic accuracy, fluid responsiveness, transfusion requirements, intensive care unit (ICU) admission, and mortality. IVC-US demonstrated a sensitivity of 71% and specificity of 75% in detecting hypovolemia. A smaller IVC diameter (<1.5 cm) was significantly associated with increased ICU admissions (51.3%), higher transfusion rates (12.2%), increased emergency surgery requirements (16.2%), and elevated mortality (13.5%). Additionally, an IVC-CI greater than 38.5% provided 80% sensitivity and 85.7% specificity for predicting fluid responsiveness in patients with major blunt trauma. Post-resuscitation assessments (IVC-CI ≤28.6%) were predictive of fluid unresponsiveness (80% sensitivity, 75% specificity). Moreover, IVC-US reliably predicted 24-hour fluid requirements, helping in real-time fluid management. Integrating IVC-US into the eFAST as the e²FAST protocol enhances diagnostic accuracy for identifying hemorrhagic shock and provides critical real-time guidance for fluid resuscitation. Given its non-invasive nature, reliability, and predictive value for patient outcomes, standardized inclusion of IVC measurements in trauma protocols is recommended. Future research should prioritize multicenter randomized trials and standardized operator training to minimize variability and support broad clinical implementation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.026 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".