Diagnostic Accuracy of Serial Focused Assessment Sonography in Blunt Abdominal Trauma: A Systematic Review and Meta-Analysis
Archives of Academic Emergency Medicine,
Vol. 14 No. 1 (2026),
1 October 2025
,
Page e64
https://doi.org/10.22037/aaem.v14i1.3162
Abstract
Introduction: A single Focused Assessment with Sonography for Trauma (FAST) examination has limited sensitivity in blunt abdominal trauma (BAT) because free-fluid detection is volume- and time-dependent. This systematic review and meta-analysis aimed to evaluate the pooled diagnostic accuracy of repeated or serial FAST in blunt abdominal trauma. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for diagnostic test accuracy (PRISMA-DTA) and PRISMA 2020 statements, we searched databases for studies reporting the accuracy of serial FAST against a reference standard (abdominal computed tomography (CT) scan, surgery, diagnostic peritoneal aspiration, or clinical follow-up) in BAT patients. Two-by-two data were pooled with bivariate random-effects models (Reitsma; Nyaga generalized linear mixed model (GLMM)); sensitivity and specificity were also pooled separately (DerSimonian–Laird). Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 and certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Eleven studies (>2,800 patients) were included; seven with a complete 2×2 table entered the primary model, two provided sensitivity only, and two were not comparable. Pooled sensitivity was 0.85 (95% confidence interval (CI): 0.77–0.90) and specificity 0.98 (95% CI: 0.92–0.99); positive and negative likelihood ratios were 41.0 (95% CI: 10.7–156.7) and 0.15 (95% CI: 0.10–0.24), and the diagnostic odds ratio 265 (95% CI: 67–1046). Adding the sensitivity-only studies raised sensitivity to 0.87 (95% CI: 0.80–0.93). Specificity was higher in adults than children (0.99 vs 0.90; p<0.001); sensitivity did not differ (p = 0.52). Sensitivity rose with the timing of the repeat scan, from 0.64 at 4 hours to 0.88 at 12 hours. Certainty of evidence was Low. Conclusions: Serial FAST has high specificity and moderate, time-dependent sensitivity, with a large positive likelihood ratio. Because the certainty of the evidence is low, these estimates should be interpreted cautiously. A positive result markedly increases the probability of intra-abdominal injury, whereas a negative result does not exclude it and requires structured observation or definitive imaging.
- Focused Assessment with Sonography for Trauma
- Abdominal Injuries
- Sensitivity and Specificity
- Meta-Analysis
How to Cite
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