Ces radiol. 2014, 68(2):129-136

Multi-detector row computed tomography in trauma - influence of the localization, size and density of active extravasation on subsequent clinical managementOriginal article

Filip Cihlář¹, Roman Mišičko², Antonín Krajina³, Jiří Cihlář⁴, Robert Bartoš⁵, Petr Obruba², Petra Zasadilová¹

¹ Radiologické oddělení, Masarykova nemocnice o.z., Krajská zdravotní a.s., Ústí nad Labem

² Traumacentrum, Masarykova nemocnice o.z., Krajská zdravotní a.s., Ústí nad Labem

³ Radiologická klinika LF UK a FN, Hradec Králové

⁴ Katedra matematiky, Přírodovědecká fakulta UJEP, Ústí nad Labem

⁵ Neurochirurgická klinika UJEP, Masarykova nemocnice o.z., Krajská zdravotní a.s., Ústí nad Labem

Aim: Detection rate of active bleeding in extraabdominal localization and number of nonoperative treatment is increasing in trauma evaluated by whole-body multi-detector row computed tomography (MDCT) imaging. The aim of the study is to evaluate a MDCT detection of the active bleeding in trauma patients, influence of the localization, size and density of active extravasation on subsequent clinical management.

Methods: The authors evaluated consecutive trauma patients examined between 2004-2008 and 2010-2013 who underwent whole-body or abdominal MDCT, and were examined 967 patients. We retrospectively reviewed MDCT images for the presence of extravasated contrast material, findings that represents active hemorrhage. The site and number of the bleeding sites was noted. The size, area, density and relative density of the hemorrhage was noted. We also evaluated systolic blood pressure on admission, hemodynamic status, Injury Severity Score and Glasgow coma scale. Results were compared with clinical follow up or intraoperative findings (nonoperative management vs. intervention).

Results: Active bleeding was detected in 128 (13,2%) of 967 patients. A total of 183 sources of active extravasation were identified. Eighty-six (47%) of 183 bleeding sites underwent immediate intervention - surgical or endovascular. Subsequent clinical management is strongly dependent on the site of active extravasation (p = 0,00001). The size (p = 0,00001), area (p = 0,00001), density (p = 0,00542) and relative density (p = 0,01919) of active extravasation were significantly higher in patients who underwent intervention.

Conclusion: Location of the site of active extravasation is important predictor of subsequent clinical management. The size, area, density and relative density of active extravasation were also important predictors of subsequent clinical management.

Keywords: trauma, active bleeding, multi-detector row computer tomography

Accepted: April 4, 2014; Published: June 1, 2014  Show citation