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CT signs of hypovolemic shock complex in patients with non-traumatic shock
Israel Cohen1,2, Noam Tau3,4, Ruth Lekach4
1Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel. Israelc38@gmail.com.
Insights
Hypovolemic shock complex (HSC) signs are common in non-traumatic shock patients. Identifying two or more HSC signs on CT scans indicates a higher mortality risk, especially with signs of shock liver.
Area of Science:
- Radiology
- Emergency Medicine
- Critical Care
Background:
- Undifferentiated non-traumatic shock presents a diagnostic challenge in the emergency department.
- Computed Tomography (CT) is frequently utilized to investigate the causes of shock.
Purpose of the Study:
- To determine the frequency of hypovolemic shock complex (HSC) signs on CT in patients with non-traumatic shock.
- To evaluate the association between HSC signs and all-cause mortality.
Main Methods:
- Retrospective analysis of 100 patients undergoing contrast-enhanced thoraco-abdominal CT for non-traumatic shock.
- CT scans were reviewed for HSC signs, and patients were subtyped based on shock etiology.
- Demographic data and 90-day mortality were collected.
Main Results:
- Over half of patients (58%) exhibited at least one HSC sign on CT.
- Flattened inferior vena cava and adrenal hyper-enhancement were the most frequent HSC signs.
- Patients with two or more HSC signs had significantly higher mortality (73.5% vs. 45.2%).
Conclusions:
- HSC signs are prevalent in patients with non-traumatic shock.
- The presence of multiple HSC signs on CT is linked to increased mortality.
- Shock liver identified on CT was a significant predictor of higher mortality.
Purpose:
To assess the frequency of hypovolemic shock complex (HSC) signs on CT in patients who presented to the emergency department (ED) with undifferentiated non-traumatic shock. Secondary aim was to assess the correlation between HSC signs and all-cause mortality.
Methods:
This retrospective, single-center study included 100 patients who underwent contrast-enhanced thoraco-abdominal CT in the ED to evaluate the etiology for non-traumatic undifferentiated shock. All patients were retrospectively assigned a shock subtype (i.e., distributive, cardiogenic, hypovolemic, obstructive, multifactorial, and unknown) based on medical records. Patients' demographics and time to all-cause mortality up to 90 days were collected. All CT studies were re-assessed for the presence of HSC signs. Correlation between HSC signs, mortality and shock subtype was assessed.
Results:
Overall, 58% (58/100) of all patients had at least one HSC sign. Flattened inferior vena cava and adrenal hyper-enhancement were the most common HSC signs (27.3%, 27/99; in both). Overall mortality was 59% (59/100). When evaluated separately, shock liver was the only HSC sign to significantly correlate with increased mortality (84.6% vs. 55.2%, p = .04). However, patients with at least two HSC signs had a significantly higher mortality rate compared to patients without any HSC signs (73.5% vs. 45.2%, p = .017).
Conclusion:
Most patients with non-traumatic shock had at least one HSC sign. Mortality rates were significantly higher in patients with two or more HSC signs compared to patients without any signs. Patients with shock liver sign had significantly higher mortality rates.
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