Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지

Prognosis for Blunt Abdominal Trauma Patients with Contrast Extravasation on the Abdominopelvic CT Scan

조영제 혈관 외 유출이 관찰된 복부 둔상 환자의 유출부위에 따른 예후

  • Shin, Hyung Jin (Department of Emergency Medicine, Wonju College of Medicine, Yonsei University) ;
  • Lee, Kang Hyun (Department of Emergency Medicine, Wonju College of Medicine, Yonsei University) ;
  • Kwak, Young Soo (Department of Emergency Medicine, Wonju College of Medicine, Yonsei University) ;
  • Kim, Sun Hyu (Department of Emergency Medicine, Ulsan University Hospital) ;
  • Kim, Hyun (Department of Emergency Medicine, Wonju College of Medicine, Yonsei University) ;
  • Hwang, Sung Oh (Department of Emergency Medicine, Wonju College of Medicine, Yonsei University)
  • 신형진 (연세대학교 원주의과대학 응급의학교실) ;
  • 이강현 (연세대학교 원주의과대학 응급의학교실) ;
  • 곽영수 (연세대학교 원주의과대학 응급의학교실) ;
  • 김선휴 (울산대학교병원 응급의학과) ;
  • 김현 (연세대학교 원주의과대학 응급의학교실) ;
  • 황성오 (연세대학교 원주의과대학 응급의학교실)
  • Received : 2009.04.29
  • Accepted : 2009.05.27
  • Published : 2009.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Computed tomography (CT) is an accurate test for evaluating hemodynamically stable patients with blunt abdominal trauma. Until now, there have been few studies concentrating on the diagnostic and prognostic significance of the intravenous contrast extravasation (CE) site. We investigated the site of CE on abdominopelvic CT (APCT) and its effect on treating trauma patients and predicting the clinical outcome. Methods: The 50 patients admitted to our emergency department with blunt abdominal trauma showing CE on APCT from January 2004 to September 2006 were included in this study. Patients were prospectively collected, and medical records were reviewed and analyzed. The patients'clinical and lab findings, Focused Assessment with Sonography for Trauma (FAST) findings, CT findings were analyzed. CE sites were classified as intraperitoneal, retroperitoneal, and pelvic cavity and were correlated with post-treatment complications, mortality, and morbidity. Results: Of the 50 patients (mean age : $45{\pm}18years$, 29 males, 21 females) included in our study, 33 patients died (66%). There was no correlation between CE site and ICU or total hospitalization duration (p=0.553, p=0.523). During the first 24 hours of resuscitation, the pelvic cavity group required a mean of 20 units more of packed red blood cell (pRBC) transfusion compared to other groups (p=0.003). In the intraperitoneal group, more patients received operative invasive intervention - either laparotomy or embolization (p=0.025). The intraperitoneal group had the highest mortality, with 13 deaths (11/33, 39%), and the highest early mortality rate (10/13, 76%) in the first 24 hours (p=0.001). Conclusion: Intraperitoneal CE on the CT scan in cases of blunt abdominal trauma is regarded as an indication of a need for invasive intervention (either angiography or laparotomy) and of a higher mortality rate in the first 24 hours. A pelvic cavity CE rquires more aggressive transfusion with pRBC. However, the CT findings themselves showed no significant correlation with overall mortality, morbidity, or hospitalization.

Keywords

References

  1. Cho YD, Hong YS, Lee SW, Choi SH, Yoon YH, Lim SI, et al. Impact of Initial Helical Abdominal Computed Tomography on the Diagnosis of Hollow Viscus Injury and Blunt Abdominal Trauma. J Korean Soc Traumatol 2008;21:28-35
  2. Kim HS, Hwang SY, Won HS, Kim SE, Park CW, Lee K. A Clinical Study of Abdominal CT in Blunt Abdominal Trauma, J Korean Soc Emerg Med 1994;5:100-6
  3. Viscomi GN, Gonzalez R, Taylor KJ, Crade M. Ultrasonic evaluation of hepatic and splenic trauma. Arch Surg. 1980;115:320-1 https://doi.org/10.1001/archsurg.1980.01380030066014
  4. Yao DC, Jeffrey RB Jr, Mirvis SE, Weekes A, Federle MP, Kim C, et al. Using contrast-enhanced helical CT to visualize arterial extravasation after blunt abdominal trauma: incidence and organ distribution. AJR Am J Roentgenol. 2002;178:17-20 https://doi.org/10.2214/ajr.178.1.1780017
  5. Willmann JK, Roos JE, Platz A, Pfammatter T, Hilfiker PR, Marincek B, et al. Multidetector CT: detection of active hemorrhage in patients with blunt abdominal trauma. AJR Am J Roentgenol. 2002;179:437-44 https://doi.org/10.2214/ajr.179.2.1790437
  6. Stephen DJ, Kreder HJ, Day AC, McKee MD, Schemitsch EH, ElMaraghy A, et al. Early detection of arterial bleeding in acute pelvic trauma. J Trauma. 1999;47:638-42 https://doi.org/10.1097/00005373-199910000-00006
  7. Fang JF, Chen RJ, Wong YC, Lin BC, Hsu YB, Kao JL, et al. Pooling of contrast material on computed tomography mandates aggressive management of blunt hepatic injury. Am J Surg. 1998;176:315-9 https://doi.org/10.1016/S0002-9610(98)00196-2
  8. Jeffrey RB Jr, Cardoza JD, Olcott EW. Detection of active intraabdominal arterial hemorrhage: value of dynamic contrastenhanced CT. AJR Am J Roentgenol. 1991;156:725-9 https://doi.org/10.2214/ajr.156.4.2003435
  9. Taylor GA, Kaufman RA, Sivit CJ. Active hemorrhage in children after thoracoabdominal trauma: clinical and CT features. AJR Am J Roentgenol. 1994;162:401-4 https://doi.org/10.2214/ajr.162.2.8310935
  10. DiGiacomo JC, McGonigal MD, Haskal ZJ, Audu PB, Schwab CW. Arterial bleeding diagnosed by CT in hemodynamically stable victims of blunt trauma. J Trauma. 1996;40:249-52 https://doi.org/10.1097/00005373-199602000-00012
  11. Federle MP, Courcoulas AP, Powell M, Ferris JV, Peitzman AB. Blunt splenic injury in adults: clinical and CT criteria for management, with emphasis on active extravasation. Radiology. 1998;206:137-42
  12. Pereira SJ, O'Brien DP, Luchette FA, Choe KA, Lim E, Davis Jr K, et al. Dynamic helical computed tomography scan accurately detects hemorrhage in patients with pelvic fracture. Surgery. 2000;128:678-85 https://doi.org/10.1067/msy.2000.108219
  13. Novelline RA, Rhea JT, Rao PM, Stuk JL. Helical CT in emergency radiology. Radiology. 1999;213:321-39
  14. Fang JF, Wong YC, Lin BC, Hsu YP, Chen MF. Usefulness of multidetector computed tomography for the initial assessment of blunt abdominal trauma patients. World J Surg. 2006;30:176-82 https://doi.org/10.1007/s00268-005-0194-7
  15. Fang JF, Chen RJ, Wong YC, Lin BC, Hsu YB, Kao JL, et al. Classification and treatment of pooling of contrast material on computed tomographic scan of blunt hepatic trauma. J Trauma. 2000;49:1083-8 https://doi.org/10.1097/00005373-200012000-00018
  16. Wong YC, Wang LJ, See LC, Fang JF, Ng CJ, Chen CJ. Contrast material extravasation on contrast-enhanced helical computed tomographic scan of blunt abdominal trauma: its significance on the choice, time, and outcome of treatment. J Trauma. 2003;54:164-70 https://doi.org/10.1097/00005373-200301000-00021
  17. Diamond IR, Hamilton PA, Garber AB, Tien HC, Chughtai T, Rizoli SB, et al. Extravasation of Intravenous Computed Tomography Scan Contrast in Blunt Abdominal and Pelvic Trauma. J Trauma. 2009;66:1102-7 https://doi.org/10.1097/TA.0b013e318174f13d