Hepatic and splenic blush on computed tomography in children following blunt abdominal trauma: Is intervention necessary?

Martha Conley E. Ingram, Ragavan V. Siddharthan, Andrew D. Morris, Sarah J. Hill, Curtis D. Travers, Courtney E. McKracken, Kurt F. Heiss, Mehul V. Raval, Matthew T. Santore*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

BACKGROUND: There are no widely accepted guidelines for management of pediatric patients who have evidence of solid organ contrast extravasation ("blush") on computed tomography (CT) scans following blunt abdominal trauma. We report our experience as a Level 1 pediatric trauma center in managing cases with hepatic and splenic blush. METHODS: All pediatric blunt abdominal trauma cases resulting in liver or splenic injury were queried from 2008 to 2014. Patients were excluded if a CTwas unavailable in the medical record. The presence of contrast blush was based on final reports from attending pediatric radiologists. Correlations between incidence of contrast blush and major outcomes of interest were determined using χ 2 and Wilcoxon rank-sum tests for categorical and continuous variables, respectively, evaluating statistical significance at p < 0. 05. RESULTS: Of 318 patients with splenic or liver injury after blunt abdominal trauma, we report on 30 patients (9%) with solid organ blush, resulting in 18 cases of hepatic blush and 16 cases of splenic blush (four patients had extravasation from both organs). Blush was not found to correlate significantly with age, gender, or type of injury (liver vs. splenic) but was found to associatewith higher grades of solid organ injury (p = 0. 002) and higher ISS overall (p < 0. 001). Patients with contrast blush on imaging were more likely to be admitted to the intensive care unit (90% vs. 41%, p < 0. 001), receive blood products, (50% vs. 12%, p < 0. 001), and be considered for an intervention (p < 0. 001). Eighty percent of patients with an isolated contrast blush of the spleen or liver did not require an operation. Only 17% of patients with blush required definitive treatment, such as embolization (n = 1), packing (n = 1), or splenectomy (n = 3). Blush had no significant correlation with overall survival (p = 0. 13). CONCLUSIONS: The finding of a blush on CT from a splenic or liver injury is associatedwith higher grade of injury. These patients receive intensive medicalmanagement but do not uniformly require invasive intervention. From our data, we suggest that a blush can safely bemanaged nonoperatively and that treatment should be dictated by change in physiology.

Original languageEnglish (US)
Pages (from-to)266-270
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume81
Issue number2
DOIs
StatePublished - Jan 1 2016

Keywords

  • Blunt abdominal trauma
  • Blush
  • Nonoperative management
  • Pediatric

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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