(O-A5) Utilization of Contrast-enhanced Ultrasound in the Setting of Blunt Abdominal Trauma

Objectives: The purpose of this scoping review is to examine the breadth of evidence related to using CEUS during the FAST exam.

Background: Contrast-enhanced ultrasound (CEUS) provides a prompt, reproducible, repeatable, and safe method of identifying solid organ injury of the abdomen; however, it is rarely used in the initial evaluation of trauma. Understanding that this contrast agent is safe and lacks ionizing radiation, it may be of particular benefit to children and those with renal or hepatic impairment. There is existing literature showing that using CEUS during focused assessment for trauma (FAST) can improve sensitivity and specificity when compared to traditional FAST exams.

Methods: The authors followed the Joanna Briggs Institute approach to conducting scoping reviews. In 2022, the authors systematically searched Pubmed, ScienceDirect, EMBASE, and SCOPUS for eligible studies published between 1990 - November 2022. Three reviewers screened articles independently for those that met inclusion criteria and extracted data in a duplicate record. When eligible studies were found, the reviewers searched their references for further eligible studies. If abstracts were subsequently published, the abstract was excluded in favor of the published paper. A third-party reviewer will serve as a tiebreaker to resolve any disagreement.

Results: At this point, the study is ongoing. 356 studies have been screened, and 52 have been selected to include. The selected literature includes 2 meta-analyses, 15 literature reviews, 16 comparative studies, 5 cohort studies, 5 clinical trials, 1 abstract, 2 evaluation studies, 5 case studies, and 1 essay. These studies examined the performance of contrast-enhanced ultrasound in identifying intrabdominal injury in both adult and pediatric populations when compared to computed tomography and traditional ultrasound. Of the 52 studies selected, the first was published in 2003, and the most recent was in 2022. 16 (30.8%) were published in the years 2003-2007, 10 (19.2%) in the years 2008-2012, 15 (28.8%) in the years 2013-2017, and 11 (21.2%) between 2018-November 2022.

Conclusions: According to the reviewed literature in this ongoing study, the role of CEUS in the FAST exam remains unclear. Many of the studies were underpowered, and the conclusions drawn varied. Additionally, much of the literature lacked a specific research question, making it difficult to draw useful clinical information from the studies. While further research is needed, there is consistent evidence that this safe and widely tolerated study has improved sensitivity and specificity when compared to traditional FAST exam.

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Funding (Optional): None