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"Blush" on trauma computed tomography: not as bad as we think!
Maria Michailidou1, George C Velmahos, Gwendolyn M van der Wilden
1Division of Trauma, Emergency Surgery, and Surgical Critical Care and the Department of Biostatistics and Epidemiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
The Journal of Trauma and Acute Care Surgery
|August 30, 2012
Summary
Nearly half of intravenous contrast extravasations (IVCE) on trauma CT scans do not require intervention. Hypotension, severe abdominal trauma, and large IVCE size predict the need for intervention.
Area of Science:
- Radiology
- Trauma Surgery
- Emergency Medicine
Background:
- Intravenous contrast extravasation (IVCE) is increasingly identified on computed tomography (CT) scans in trauma patients.
- Historically, IVCE has often led to interventions like angiographic embolization or surgery.
Purpose of the Study:
- To evaluate the necessity of interventions for IVCE identified on trauma CT scans.
- To identify predictors of intervention for IVCE in trauma patients.
Main Methods:
- Retrospective analysis of trauma patients with IVCE on abdominal/pelvic CT scans (2005-2009).
- Examined IVCE characteristics (size, location, containment) and patient variables (hemodynamics, injury severity) as risk factors for intervention.
- Multivariate analysis was used to identify independent predictors of intervention.
Main Results:
- 81 IVCEs were identified in 69 patients.
- 43.5% of patients with IVCE were managed non-operatively.
- Independent predictors for intervention included low admission systolic blood pressure (≤100 mm Hg), large IVCE (>1.5 cm), and severe abdominal injury (Abbreviated Injury Score ≥3).
Conclusions:
- A significant proportion of IVCEs on trauma CT scans do not necessitate intervention.
- Hypotension on admission, severe abdominal trauma, and IVCE size ≥1.5 cm are key indicators for requiring intervention.
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