• Eur J Trauma Emerg Surg · Dec 2024

    Review Meta Analysis

    Contrast-enhanced CT scan (CECT) for the detection of hollow viscus and mesenteric injuries in blunt trauma - an updated systematic review of the literature and meta-analysis of diagnostic test accuracy.

    • Stefano Granieri, Michele Altomare, Alessandro Bonomi, Giada Panagini, Simone Frassini, Stefano Piero Bernardo Cioffi, Giorgio Basta, Andrea Spota, Fabrizio Sammartano, Roberto Bini, Federica Renzi, Elisa Reitano, Osvaldo Chiara, and Stefania Cimbanassi.
    • General Surgery Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, Vimercate, 20871, Italy. steff.granieri@gmail.com.
    • Eur J Trauma Emerg Surg. 2024 Dec 1; 50 (6): 270927192709-2719.

    BackgroundDespite improved awareness of blunt traumatic hollow viscus and mesenteric injuries (THVMI), the accuracy of contrast-enhanced CT (CECT) varies considerably among studies. This systematic review and meta-analysis of test accuracy aims to explore the diagnostic performance of CECT in detecting THVMI in blunt trauma.MethodsThe study was conducted according to the Cochrane recommendations searching the PubMed, Scopus, and Cochrane Library datasets from 2000 to 8 September 2023 (PROSPERO ID: CRD42023473041). Surgical exploration, autopsy, and discharge from the hospital after monitoring were set as reference standard. To explore the diagnostic accuracy of CECT in detecting THVMI hierarchical models were developed. The risk of bias in individual studies was assessed with the QUADAS-2 tool. Sensitivity analysis was conducted to detect sources of heterogeneity.ResultsTwelve studies, for a total of 4537 patients, were deemed eligible. After identification of outliers and sensitivity analysis, the pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were 0.85 (95% CI: 0.69-0.93), 0.94 (95% CI: 0.8-0.98), 14.65 (95% CI: 4.22-50.85), 0.16 (95% CI: 0.07-0.34), 92.3 (95% CI: 29.75-286.34), respectively. The Area under the HSROC curve was 0.95 (95% CI: 0.92-0.96). Meta-regression analysis identified the year of publication as a covariate significantly associated with heterogeneity. A high risk of bias was detected in the "patient selection" domains.ConclusionCECT has a fundamental role in identifying THVMI with high specificity but suboptimal sensitivity. Clinical criteria are still of paramount importance, especially in cases of ambiguous initial CECT images.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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