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Active hemorrhage in children after thoracoabdominal trauma: clinical and CT features
G A Taylor1, R A Kaufman, C J Sivit
1Russell H. Morgan Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD 21287.
Insights
Children with active hemorrhage on CT scans after thoracoabdominal trauma often survive, despite severe injuries and hemodynamic instability. This finding challenges the assumption of uniformly poor outcomes in pediatric trauma patients with active bleeding.
Area of Science:
- Pediatric Traumatology
- Radiology
- Emergency Medicine
Background:
- Closed thoracoabdominal trauma in children can lead to active hemorrhage.
- Computed tomography (CT) is crucial for evaluating trauma injuries.
- The clinical outcomes of children with active hemorrhage on CT are not well-defined.
Purpose of the Study:
- To review clinical features and CT evidence of active hemorrhage in pediatric thoracoabdominal trauma.
- To evaluate the hypothesis that active hemorrhage on CT uniformly predicts poor outcomes in children.
Main Methods:
- Retrospective review of CT scans from approximately 3000 children with trauma.
- Identification of active hemorrhage (extravasation of contrast material) on CT scans.
- Recording of hemorrhage location/severity, organ injury, clinical status, treatment, and outcomes.
Main Results:
- Seven cases of active hemorrhage identified (abdomen/chest).
- Injuries included solid organ and vascular damage; most had intraperitoneal fluid and signs of hypoperfusion.
- Four children became hypotensive during CT; six required surgery; two died.
Conclusions:
- Children with active hemorrhage on CT have a distinct injury spectrum compared to adults.
- Despite hemodynamic instability and surgical needs, most pediatric patients with active hemorrhage on CT survive.
Objective:
We reviewed the clinical features and CT evidence of active hemorrhage in children undergoing CT studies because of closed thoracoabdominal trauma. Our purpose was to evaluate the hypothesis that children with this CT finding have uniformly poor clinical outcomes.
Materials And Methods:
The CT records of approximately 3000 children undergoing CT evaluation for trauma at four geographically distinct pediatric trauma centers were reviewed for the presence of active hemorrhage on CT scans. The location and severity of active hemorrhage, accompanying organ injury, initial clinical information, type of treatment (surgical or nonsurgical), and clinical outcome were recorded.
Results:
Seven CT studies showing acute extravasation of intravascular contrast material in the abdomen (six) or chest (one) were identified. Hemorrhage was caused by severe solid organ injury in four children (three with hepatic injury and one with splenic injury) and by vascular injury to the internal iliac artery, segmental pulmonary artery, and descending colon in one child each. Every child with abdominal injuries had large collections of intraperitoneal fluid, and three children had abdominal CT signs of hypoperfusion. Although all patients were hemodynamically stable initially, four children became hypotensive during CT examination. Six children required surgical intervention because of ongoing blood loss, and two children died.
Conclusion:
Our results suggest that children with CT evidence of active hemorrhage have a different spectrum of injuries than that seen in adults. Despite the high rate of hemodynamic instability and need for urgent surgical intervention, most children with this CT finding survive.