Diagnostic accuracy of contrast enhanced ultrasound in patients with blunt abdominal trauma presenting to the emergency department: a systematic review and meta-analysis

Abstract

We aimed to investigate the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) in evaluating blunt abdominal trauma for patients presenting to the emergency department. Electronic search of Scopus and Pubmed was performed from inception to September 2016. Human studies investigating the diagnostic accuracy of CEUS in identifying abdominal solid organ injuries were included. Risk of bias was assessed using the QUADAS tool. A total of 10 studies were included in the study and 9 of them were included for meta-analysis. The log(DOR) values ranged from 3.80 (95% CI: 2.81–4.79) to 8.52 (95% CI: 4.58–12.47) in component studies. The combined log(DOR) was 6.56 (95% CI: 5.66–7.45). The Cochran’s Q was 11.265 (p = 0.793 with 16 degrees of freedom), and the Higgins’ I2 was 0%. The CEUS had a sensitivity of 0.981 (95% CI: 0.868–0.950) and a false positive rate of 0.018 (95% CI: 0.010–0.032) for identifying parenchymal injuries, with an AUC of 0.984. CEUS performed at emergency department had good diagnostic accuracy in identifying abdominal solid organ injuries. CEUS can be recommended in monitoring solid organ injuries, especially for patients managed with non-operative strategy.

New Perspectives for Modern Trauma Management – Lessons Learned from 25 Years FAST and 15 Years E-FAST

“…The application of CEUS seems particularly promising. A recent meta-analysis of nine studies comparing CEUS to contrast-enhanced CT in adult blunt trauma patients showed excellent sensitivity for CEUS of 0.981 (95 % CI: 0.868-0.950) and a false-positive rate of 0.018 (95 % CI: 0.010-0.032) for identifying parenchymal injuries [61]. The accuracy of CEUS in adult trauma patients is close to the sensitivity and specificity of contrast-enhanced CT. CEUS seems to be especially relevant for the up to 37 % of pediatric trauma patients that have abdominal parenchymal injuries verified on CT [62,63] but did not show evidence of free abdominal fluid on conventional B-mode ultrasound.…”

Management of Hepatic Trauma: An Update

“…41 In a meta-analysis consisting of nine studies, the sensitivity and false-positive rate for detecting hepatic injury using CEUS was 94 and 1%. 42 CEUS can be considered as first-line imaging in centers where ultrasound is part of the initial trauma screening protocol. 43,44 More importantly, it is especially useful for serial monitoring for conservatively managed patients without exposing them to further radiation.…”

Protocol for a prospective observational study on the association of variables obtained by contrast-enhanced ultrasonography and sepsis-associated acute kidney injury

“…Contrast-enhanced ultrasonography (CEUS) which is a relatively novel modality with microbubble-based contrast agents have provided real-time anatomic and functional information in the study of microvascular fow in patients with SA-AKI without ionising radiation 16. Currently, CEUS has become widely used in the emergency department for evaluating cases of abdominal blunt trauma17; however, the use of CEUS in SA-AK cases is limited and it remains unclear whether it can provide useful information for predicting the development.…”