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Significance of 'blush' on computed tomography scan in children with liver injury
James W Eubanks1, Donald E Meier, Barry A Hicks
1Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Insights
Children with active bleeding ("blush") on CT scans after blunt liver injury face higher transfusion needs and mortality risks. This finding highlights the importance of early detection in pediatric trauma care.
Area of Science:
- Pediatric Surgery
- Radiology
- Trauma Care
Background:
- Blunt liver injury is a common consequence of abdominal trauma in children.
- The presence of
- blush
- on computed tomography (CT) indicates active bleeding.
- Its impact on clinical outcomes in pediatric blunt liver injury is not well-established.
Purpose of the Study:
- To investigate whether the presence of
- blush
- on abdominal CT in children with blunt liver injury is associated with adverse clinical outcomes.
- To compare outcomes between pediatric patients with and without
- blush
- on initial CT scans.
Main Methods:
- Retrospective review of 105 children (ages 1-16) with blunt liver injury.
- Analysis of admission contrast-enhanced CT scans for
- blush
- and injury grade.
- Exclusion of patients with low-grade injuries (I-II) and arterial embolization.
- Comparison of clinical outcomes (transfusion, operations, mortality) between severe injury groups with (n=22) and without (n=53)
- blush
- using Fisher's Exact and Mann-Whitney U tests.
Main Results:
- Patients with
- blush
- required significantly larger transfusion volumes (17.3 vs. 5.0 mL/kg) and had a higher mortality rate (23% vs. 4%).
- Injury Severity Score (ISS) was also significantly greater in the
- blush
- group (25.8 vs. 17.5).
- No significant differences were observed in ICU stay, hospital length of stay, or operations performed.
Conclusions:
- The presence of
- blush
- on CT in pediatric blunt liver injury is a marker for increased transfusion requirements and mortality risk.
- Mortality in these patients is predominantly linked to the severity of associated injuries.
- Early identification of
- blush
- may aid in risk stratification and management of pediatric blunt liver trauma.
Background/Purpose:
The aim of this study was to determine if the presence of "blush" (an indication of active bleeding) on abdominal CT in children with blunt liver injury adversely affected their clinical outcome as has been reported in adults.
Methods:
The authors reviewed the records of 105 children ages 1 to 16 years with blunt liver injury seen on admission IV contrast CT seen over a 6-year period. Demographic characteristics measured were age, mechanism of injury, and injury severity score (ISS). Clinical outcomes included ICU stay, hospital length of stay (LOS), transfusion requirement (milliliters per kilogram), operations performed, and mortality rate. CT scans were evaluated retrospectively by a radiologist blinded to prior reports, for a "blush" and grade of liver injury. No patient underwent arterial embolization. The authors eliminated children with grade I-II injuries (30 patients), because only one had a blush, and analyzed the 75 patients with severe liver injuries (grades III-V). Those patients without a blush (n = 53) seen on CT were the control group, whereas patients with a blush (n = 22) were the study group. Data were analyzed using the Fisher's Exact and Mann-Whitney U test. The level of significance was set at.05.
Results:
Patients with a blush had a significantly larger transfusion requirement (17.3 +/- 30.5 mL/kg v 5.0 +/- 10.9 mL/kg; P =.02) and mortality rate (23% v 4%; P =.02), but the ISS also was significantly greater (25.8 +/- 14.5 v 17.5 +/- 12.2; P =.019). All other data were similar between the 2 groups.
Conclusions:
Children with a blush seen on abdominal CT after blunt liver injury have higher transfusion requirements and greater risk of mortality than those without blush. Mortality is primarily related to the severity of their other injuries.
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