ความแม่นยำของการตรวจอัลตราซาวด์ฉุกเฉินในการวินิจฉัยการบาดเจ็บช่องท้องเมื่อเปรียบเทียบกับการตรวจเอกซเรย์คอมพิวเตอร์และการศึกษาลักษณะอวัยวะที่บาดเจ็บจากภาพเอกซเรย์คอมพิวเตอร์ในโรงพยาบาลหัวหิน

Suphatcharee Aroonsiriwattana

Authors

Suphatcharee Aroonsiriwattana Department of radiology, Huahin hospital

Keywords:

Blunt abdominal trauma, FAST, Computed tomography, Diagnostic accuracy, Organ injury

Abstract

Background: Blunt Abdominal Trauma (BAT) is a common emergency condition and a major cause of morbidity and mortality. Focused Assessment with Sonography in Trauma (FAST) is widely used for rapid initial assessment, whereas computed tomography (CT) remains the gold standard for diagnosing intra-abdominal injuries.

Objectives: To evaluate the diagnostic accuracy of FAST compared with CT as the reference standard for intra-abdominal injury detection and to characterize organ injury patterns and severity identified on CT in patients with BAT at Hua Hin Hospital.

Methods: A retrospective cohort study was conducted in patients diagnosed with BAT who underwent both FAST and CT at Hua Hin Hospital from August 1, 2020 to August 1, 2025. CT was used as the reference standard. Diagnostic performance of FAST was assessed using sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV).

Results: A total of 218 patients were included. FAST demonstrated a sensitivity of 91.2%, specificity of 92.3%, and overall accuracy of 91.3%. The PPV was high (99.5%), whereas the NPV was low (40.0%). The liver (38.53%) and spleen (29.82%) were the most commonly injured organs, with grade III injuries being the most frequently observed. Pelvic fractures were significantly associated with bladder and rectal injuries (p < 0.001).

Conclusions: FAST is a useful screening tool for intra-abdominal injury and demonstrates high diagnostic value when findings are positive. However, due to its low NPV, negative FAST results cannot reliably exclude injury. Therefore, CT should be performed in patients with persistent clinical suspicion or high-risk features. CT remains essential for definitive diagnosis, injury grading, and treatment planning in patients with BAT. Although FAST demonstrated a high specificity of 84.62%, the estimate should be interpreted with caution due to the wide confidence interval resulting from the small number of CT-negative cases. Consequently, the specificity estimate may be unstable.

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