DIAGNOSTIC ACCURACY OF FOCUSED ABDOMINAL SONOGRAPHY IN GRADING HEPATIC TRAUMA KEEPING CECT ABDOMEN AS GOLD STANDARD
DOI:
https://doi.org/10.71000/23edtg42Keywords:
Diagnostic Accuracy, Emergency Medicine, Focused Abdominal Sonography in Trauma (FAST), , Hepatic Trauma, , Injury Severity, Tomography, , X-Ray Computed, Trauma ImagingAbstract
Background: Hepatic trauma remains one of the most frequent and severe abdominal injuries associated with considerable morbidity and mortality in trauma care. Rapid, reliable, and non-invasive diagnostic approaches are essential to improve survival and guide treatment decisions. Focused Abdominal Sonography in Trauma (FAST) has emerged as a widely used bedside tool for detecting intra-abdominal injuries, yet its diagnostic accuracy compared with contrast-enhanced computed tomography (CECT), the gold standard, continues to be debated.
Objective: This study aimed to assess the diagnostic accuracy of FAST in detecting and grading hepatic trauma, using CECT as the reference standard.
Methods: A cross-sectional study was conducted over six months in a tertiary care hospital. A total of 130 patients aged over 18 years presenting with suspected hepatic trauma were enrolled through consecutive sampling. All patients underwent FAST examinations performed by trained emergency physicians, followed by CECT within 30–60 minutes. The diagnostic performance of FAST was evaluated by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), overall accuracy, and Cohen’s kappa coefficient. The grading of hepatic trauma was performed according to the American Association for the Surgery of Trauma (AAST) Liver Injury Scale, with CECT interpretations blinded to FAST results.
Results: FAST detected hepatic trauma with a sensitivity of 88.9%, specificity of 88.4%, PPV of 94.1%, NPV of 79.2%, and an overall accuracy of 88.5%. Substantial agreement was observed with CECT results (kappa coefficient = 0.77, p < 0.001). Concordance between FAST and CECT across injury grades was high, with agreement ranging from 83.3% in Grade V to 93.7% in Grade II injuries.
Conclusion: FAST demonstrated strong diagnostic accuracy for hepatic trauma detection and grading, confirming its role as a reliable, rapid, and non-invasive assessment tool. However, reduced sensitivity in high-grade injuries highlights the continued need for complementary CECT evaluation in severe trauma. Standardized training and consistent protocols are recommended to optimize diagnostic performance.
References
Alhazmi FA, Binmahri MK, Maqulah SF, Al Hunaiti AA, Alanazi AA, Aldhafeeri FS, Alamri SM, Alneamah AA, Alharbi AS, Almutiq RA, Almohaimeed SA. An Overview on Liver Trauma Diagnostic and Management Approach, Literature Review. Pharmacophore. 2021;12(5-2021):41-6.
Pillai AS, Kumar G, Pillai AK. Hepatic trauma interventions. InSeminars in interventional radiology 2021 Mar (Vol. 38, No. 01, pp. 096-0104). Thieme Medical Publishers, Inc..
Gilyard S, Shinn K, Nezami N, Findeiss LK, Dariushnia S, Grant AA, Hawkins CM, Peters GL, Majdalany BS, Newsome J, Bercu ZL. Contemporary management of hepatic trauma: what IRs need to know. InSeminars in Interventional Radiology 2020 Mar (Vol. 37, No. 01, pp. 035-043). Thieme Medical Publishers.
Saviano A, Ojetti V, Zanza C, Franceschi F, Longhitano Y, Martuscelli E, Maiese A, Volonnino G, Bertozzi G, Ferrara M, La Russa R. Liver trauma: management in the emergency setting and medico-legal implications. Diagnostics. 2022 Jun 13;12(6):1456.
García IC, Villalba JS, Iovino D, Franchi C, Iori V, Pettinato G, Inversini D, Amico F, Ietto G. Liver trauma: until when we have to delay surgery? A review. Life. 2022 May 6;12(5):694.
Huo Z, Wu H, Xu R, Yuan M, Zhang X. Toward eFAST autonomous robotic ultrasound imaging: system integrations and experimental studies. Science China Information Sciences. 2025 Mar;68(3):139203.
San-Millán I, Hill JC, Calleja-González J. Indirect assessment of skeletal muscle glycogen content in professional soccer players before and after a match through a non-invasive ultrasound technology. Nutrients. 2020 Apr 1;12(4):971.
Nayak SR, Yeola MP, Nayak SR, Kamath K, Raghuwanshi PS. Role of focused assessment with sonography for trauma in the assessment of blunt abdominal trauma–a review. J Evol Med Dent Sci. 2021 Jan 4;10(1):45-51.
Sawada K, Hayashi H, Nakajima S, Hasebe T, Fujiya M, Okumura T. Non‐alcoholic fatty liver disease is a potential risk factor for liver injury caused by immune checkpoint inhibitor. Journal of gastroenterology and hepatology. 2020 Jun;35(6):1042-8.
Liu JL, Bao D, Xu ZL, Zhuge XJ. Clinical value of contrast-enhanced computed tomography (CECT) combined with contrast-enhanced ultrasound (CEUS) for characterization and diagnosis of small nodular lesions in liver. Pakistan Journal of Medical Sciences. 2021 Nov;37(7):1843.
Muhammad SK, Shaikh MA, Shaikh BA. Sensitivity, specificity and predictive values of noninvasive markers of oesophageal varices in cirrhosis of liver. Asian J Med Res. 2012;1:98-102.
Liang T, Roseman E, Gao M, Sinert R. The utility of the focused assessment with sonography in trauma examination in pediatric blunt abdominal trauma: a systematic review and meta-analysis. Pediatric emergency care. 2021 Feb 1;37(2):108-18.
Devarbhavi H, Aithal G, Treeprasertsuk S, Takikawa H, Mao Y, Shasthry SM, Hamid S, Tan SS, Philips CA, George J, Jafri W. Drug-induced liver injury: Asia Pacific Association of Study of Liver consensus guidelines. Hepatology international. 2021 Apr;15:258-82.
Ronchetti, M. (2020). Torchradon: Fast differentiable routines for computed tomography. arXiv preprint arXiv:2009.14788.
Lahoud P, EzEldeen M, Beznik T, Willems H, Leite A, Van Gerven A, Jacobs R. Artificial intelligence for fast and accurate 3-dimensional tooth segmentation on cone-beam computed tomography. Journal of Endodontics. 2021 May 1;47(5):827-35.
Lun MC, Fang Y, Li C. Fast three-dimensional focused x-ray luminescence computed tomography. InMedical Imaging 2021: Biomedical Applications in Molecular, Structural, and Functional Imaging 2021 Feb 15 (Vol. 11600, pp. 303-308). SPIE.
Hsieh J, Flohr T. Computed tomography recent history and future perspectives. Journal of Medical Imaging. 2021 Sep 1;8(5):052109-.
Schwed AC, Wagenaar A, Reppert AE, Gore AV, Pieracci FM, Platnick KB, Lawless RA, Campion EM, Coleman JJ, Cohen MJ, Moore EE. Trust the FAST: Confirmation that the FAST examination is highly specific for intra-abdominal hemorrhage in over 1,200 patients with pelvic fractures. Journal of Trauma and Acute Care Surgery. 2021 Jan 1;90(1):137-42.
Bahrami-Motlagh H, Hajijoo F, Mirghorbani M, SalevatiPour B, Haghighimorad M. Test characteristics of focused assessment with sonography for trauma (FAST), repeated FAST, and clinical exam in prediction of intra-abdominal injury in children with blunt trauma. Pediatric Surgery International. 2020 Oct;36:1227-34.
Saviano A, Ojetti V, Zanza C, Franceschi F, Longhitano Y, Martuscelli E, Maiese A, Volonnino G, Bertozzi G, Ferrara M, La Russa R. Liver trauma: management in the emergency setting and medico-legal implications. Diagnostics. 2022 Jun 13;12(6):1456.
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Copyright (c) 2025 Mamoon Rasheed, Sayed Farrukh Nadeem, Saira Ahmed, Alia Shaheen, Moeen Iqbal, Qamar Mehboob (Author)
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