DIAGNOSTIC ACCURACY OF FOCUSED ABDOMINAL SONOGRAPHY IN GRADING HEPATIC TRAUMA KEEPING CECT ABDOMEN AS GOLD STANDARD

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.