Diagnostic Accuracy of Focused Assessment With Sonography for Trauma Against Contrast-Enhanced Multidetector Computed Tomography in Blunt Abdominal Trauma: A Cross-Sectional Study
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Background: Focused assessment with sonography for trauma (FAST) is widely used for rapid evaluation of blunt abdominal trauma, but its diagnostic scope is more limited than contrast-enhanced multidetector computed tomography (CE-MDCT). Objective: To determine the diagnostic performance of FAST for the study-defined intra-abdominal solid-organ injury outcome using CE-MDCT as the reference standard and to describe associated CE-MDCT findings. Methods: This cross-sectional analytical diagnostic-accuracy study included 140 patients with blunt abdominal trauma evaluated at Services Hospital, Lahore, from June 2022 to June 2023. Participants underwent FAST followed by abdominopelvic CE-MDCT. Diagnostic performance was assessed using sensitivity, specificity, predictive values, accuracy, likelihood ratios, and Cohen’s kappa. Results: FAST was positive in 66 (47.1%) participants and negative in 74 (52.9%). Against CE-MDCT, FAST demonstrated 93.8% sensitivity, 92.1% specificity, 90.9% positive predictive value, 94.6% negative predictive value, and 92.9% overall accuracy. The positive and negative likelihood ratios were 11.88 and 0.07, respectively, and agreement was high (κ=0.856). CE-MDCT additionally demonstrated active bleeding, free fluid, mesenteric tears, bowel perforation, mesenteric haematoma, and other traumatic abnormalities. Conclusion: FAST showed high diagnostic agreement with CE-MDCT for the predefined target condition in this selected cohort, while CE-MDCT provided broader characterization of associated abdominal injuries
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1. Granieri S, Altomare M, Bonomi A, Panagini G, Frassini S, Cioffi SPB, et al. Contrast-enhanced CT scan (CECT) for the detection of hollow viscus and mesenteric injuries in blunt trauma: an updated systematic review of the literature and meta-analysis of diagnostic test accuracy. Eur J Trauma Emerg Surg. 2024;50(6):2709-2719. doi:10.1007/s00068-024-02667-9.
2. Smyth L, Bendinelli C, Lee N, Reeds MG, Loh EJ, Amico F, et al. WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment. World J Emerg Surg. 2022;17(1):13. doi:10.1186/s13017-022-00418-y.
3. Kaewlai R, Chatpuwaphat J, Maitriwong W, Wongwaisayawan S, Shin CI, Lee CW. Radiologic imaging of traumatic bowel and mesenteric injuries: a comprehensive up-to-date review. Korean J Radiol. 2023;24(5):406-423. doi:10.3348/kjr.2022.0998.
4. Kazi IA, Elbanan M, Gaballah A, Abdelaziz A, Thimmappa ND, Kabir BW, et al. Pearls and pitfalls in the imaging of blunt bowel and mesenteric injury. Abdom Radiol (NY). 2026 Jul 2. doi:10.1007/s00261-026-05633-8.
5. Kim TA, Kwon J, Kang BH. Accuracy of focused assessment with sonography for trauma (FAST) in blunt abdominal trauma. Emerg Med Int. 2022;2022:8290339. doi:10.1155/2022/8290339.
6. Gamberini L, Scquizzato T, Tartaglione M, Chiarini V, Mazzoli CA, Allegri D, et al. Diagnostic accuracy for hemoperitoneum, influence on prehospital times and time-to-definitive treatment of prehospital FAST: a systematic review and individual participant data meta-analysis. Injury. 2023;54(6):1421-1431. doi:10.1016/j.injury.2023.03.024.
7. Lin KT, Lin ZY, Huang CC, Yu SY, Huang JL, Lin JH, et al. Prehospital ultrasound scanning for abdominal free fluid detection in trauma patients: a systematic review and meta-analysis. BMC Emerg Med. 2024;24(1):7. doi:10.1186/s12873-023-00919-2.
8. Sutarjono B, Kessel M, Alexander D, Grewal E. Is it time to re-think FAST? A systematic review and meta-analysis of contrast-enhanced ultrasound and conventional ultrasound for initial assessment of abdominal trauma. BMC Emerg Med. 2023;23(1):8. doi:10.1186/s12873-023-00771-4.
9. Pegoraro F, Giusti G, Giacalone M, Parri N. Contrast-enhanced ultrasound in pediatric blunt abdominal trauma: a systematic review. J Ultrasound. 2022;25(3):419-427. doi:10.1007/s40477-021-00623-6.
10. Jannatdoust P, Valizadeh P, Hassankhani A, Amoukhteh M, Ghadimi DJ, Heidari-Foroozan M, et al. Diagnostic performance of contrast-enhanced ultrasound in traumatic solid organ injuries in children: a systematic review and meta-analysis. Pediatr Radiol. 2025;55(2):226-241. doi:10.1007/s00247-024-06127-9.
11. Siddiqui F, Moriarty H, Bates DDB, LeBedis C. Imaging of blunt traumatic bowel and mesenteric injuries. Radiol Clin North Am. 2025;63(3):375-386. doi:10.1016/j.rcl.2024.11.004.
12. Weinberg JA, Peck KA, Ley EJ, Brown CVR, Moore EE, Sperry JL, et al. Evaluation and management of bowel and mesenteric injuries after blunt trauma: a Western Trauma Association critical decisions algorithm. J Trauma Acute Care Surg. 2021;91(5):903-908. doi:10.1097/TA.0000000000003327.
13. Olson MC, Bach CR, Wells ML, Andrews JC, Khandelwal A, Welle CL, et al. Imaging of bowel ischemia: an update, from the AJR special series on emergency radiology. AJR Am J Roentgenol. 2023;220(2):173-185. doi:10.2214/AJR.22.28140.
14. Wandling M, Cuschieri J, Kozar R, O'Meara L, Celii A, Starr W, et al. Multi-center validation of the Bowel Injury Predictive Score (BIPS) for the early identification of need to operate in blunt bowel and mesenteric injuries. Injury. 2022;53(1):122-128. doi:10.1016/j.injury.2021.07.026.
15. Sethi I, Aicher AE, Zawin M, Samuel M, Mukhi A, Vosswinkel J, et al. Index CT-based scoring systems in operative blunt bowel and mesenteric injury identification. J Surg Res. 2024;294:240-246. doi:10.1016/j.jss.2023.10.001.
16. Keller N, Zingg T, Agri F, Denys A, Knebel JF, Schmidt S. Significant blunt bowel and mesenteric injury: comparison of two CT scoring systems in a trauma registry cohort. Eur J Radiol Open. 2021;8:100380. doi:10.1016/j.ejro.2021.100380.
17. Bella FM, Bonfichi A, Esposito C, Zanza C, Bellou A, Sfondrini D, 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.
18. Hellenthal KEM, Porschen C, Wnent J, Lange M. Evolving role of point-of-care ultrasound in prehospital emergency care: a narrative review. Scand J Trauma Resusc Emerg Med. 2025;33(1):126. doi:10.1186/s13049-025-01443-x.
19. Hsia CC, Wang CY, Huang JF, Hsu CP, Kuo LW, Ouyang CH, et al. Diagnostic accuracy of computed tomography for the prediction of the need for laparotomy for traumatic hollow viscus injury: systematic review and meta-analysis. J Pers Med. 2021;11(12):1269. doi:10.3390/jpm11121269.
20. Okishio Y, Ueda K, Nasu T, Kawashima S, Kunitatsu K, Kato S. Surgical intervention for blunt bowel and mesenteric injury: indications and time intervals. Eur J Trauma Emerg Surg. 2021;47(6):1739-1744. doi:10.1007/s00068-019-01192-4.
21. Fu CY, Bajani F, Bokhari M, Wang SH, Cheng CT, Mis J, et al. How long of a postponement in surgery can a blunt hollow viscus injury patient tolerate? A retrospective study from the National Trauma Data Bank. Surgery. 2022;171(2):526-532. doi:10.1016/j.surg.2021.06.017.
22. Tominaga GT, Crandall M, Cribari C, Zarzaur BL, Bernstein M, Kozar RA. Organ Injury Scaling 2020 update: bowel and mesentery. J Trauma Acute Care Surg. 2021;91(3). doi:10.1097/TA.0000000000003319.