Department of Emergency Medicine, Brookdale University Hospital and Medical Center, 1 Brookdale Plaza, Brooklyn, NY, 11212, USA.
BMC Emerg Med. 2023 Jan 27;23(1):8. doi: 10.1186/s12873-023-00771-4.
The Focused Assessment with Sonography for Trauma (FAST) examination using conventional ultrasound has limited utility for detecting solid organ injury. Therefore, this systematic review and meta-analysis compares the performance of contrast-enhanced ultrasound (CEUS) to conventional ultrasound when used as the initial assessment for abdominal trauma prior to computed tomography (CT) imaging.
A systematic literature search of major databases was conducted of human studies investigating the diagnostic accuracy of conventional ultrasound and CEUS occurring prior to CT imaging for abdominal trauma. The study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The quality of studies was evaluated using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool. Paired pooled sensitivity and specificity between conventional ultrasound and CEUS were compared using data extracted from the eligible studies. Diagnostic odds ratio, number needed to diagnose values, and likelihood ratios were also determined.
Ten studies were included. More than half of the included studies demonstrated low risk of bias. Using McNemar's test to assess for paired binary observations, we found that CEUS had statistically higher sensitivity (0.933 vs. 0.559; two-tailed, P < 0.001) and specificity (0.995 vs. 0.979; two-tailed, P < 0.001) than conventional ultrasound in the setting of abdominal trauma, respectively. When divided into particular findings of clinical interest, CEUS had statistically higher sensitivity than conventional ultrasound in screening for active bleeding and injuries to all abdominal solid organs. CEUS also had superior diagnostic odds ratios, number needed to diagnose values, and likelihood ratios than conventional ultrasound.
The diagnostic value of CEUS was higher than that of conventional ultrasound for differentiating traumatic abdominal injuries when used as the initial assessment in the emergency department.
传统超声的创伤重点评估（FAST）检查对于检测实质器官损伤的应用有限。因此，本系统评价和荟萃分析比较了对比增强超声（CEUS）与 CT 成像前常规超声作为腹部创伤初始评估的性能。
对人类研究进行了系统的文献检索，这些研究调查了 CT 成像前常规超声和 CEUS 对腹部创伤的诊断准确性。研究遵循 PRISMA（系统评价和荟萃分析的首选报告项目）声明。使用 QUADAS-2（诊断准确性研究的质量评估 2）工具评估研究质量。从合格研究中提取数据，比较常规超声和 CEUS 之间的配对汇总敏感性和特异性。还确定了诊断比值比、需要诊断的数量值和似然比。
共纳入 10 项研究。超过一半的纳入研究显示出低偏倚风险。使用 McNemar 检验评估配对二项观察值，我们发现 CEUS 在腹部创伤中具有统计学上更高的敏感性（0.933 对 0.559；双侧，P < 0.001）和特异性（0.995 对 0.979；双侧，P < 0.001）。当分为临床关注的特定发现时，CEUS 在筛查活动性出血和所有腹部实质器官损伤方面具有统计学上更高的敏感性。CEUS 还具有比常规超声更高的诊断比值比、需要诊断的数量值和似然比。
在急诊科作为初始评估时，CEUS 对区分创伤性腹部损伤的诊断价值高于常规超声。
