David Tso MD, Presenter: Nothing to Disclose

Jennifer Wang BS, Abstract Co-Author: Nothing to Disclose

Patrick McLaughlin FFR(RCSI), Abstract Co-Author: Nothing to Disclose

Savvas Nicolaou MD, Abstract Co-Author: Nothing to Disclose

This study examined how the constellation of radiological findings seen in hypovolemic shock complex on a Multi-Detector Computed Tomography (MDCT) scan correlate with survival of polytrauma patients.

A retrospective study design was undertaken examining patients involved in severe blunt trauma with an Injury Severity Score (ISS) ≥ 16 who were admitted to the emergency department (ED) at a Level I Trauma Center between July 2011 and June 2013. Patients underwent a standardized multi-phasic whole body MDCT protocol obtained from a single CT scanner located within the ED. Radiological findings of hypovolemic shock were identified from the scan including vascular and non-vascular findings. Radiological variables were correlated with clinical and 30-day mortality data.

50 patients were identified, of which 17 died and 33 survived their injuries. The mortality cohort had lower Glasgow Coma Score (GCS) (6.0 vs. 11.9, p<0.0001) and higher ISS (43.6 vs. 31.7, p=0.002), and lower TRISS, a measure of predicted survival (23.1% vs. 70.0%, p=0.05). The mortality group had lower mean Hb (116.2 vs. 127.2 g/L, p=0.03) and higher rates of transfusion (90% vs. 47%, p=0.05). The mortality cohort demonstrated greater enhancement of the left ventricular chamber in arterial phase (330.2 vs. 261.7 HU, p=0.01). The diameter of the abdominal aorta and IVC were smaller (14.8 vs. 16.4mm, p=0.04; 12.5 vs. 15.3mm, p=0.04). The renal medulla and spleen showed lower enhancement (133.4 vs. 175.5 HU, p=0.0006, 102.7 vs. 123.4 HU, p=0.01). No statistical differences were shown with respects to myocardial, adrenal, liver, gallbladder wall, or pancreatic enhancement. No difference was seen in pulmonary vein diameter. No differences were seen with respects to the presence of shock bowel, free fluid, or halo sign around the IVC.

Small caliber of the great vessels and decrease perfusion of the spleen and renal medulla were seen in the mortality group. Contrast enhancement of the left ventricular chamber was greater in the mortality cohort which may be a novel indictor of low cardiac output or increase in systemic vascular resistance in the context of hypovolemic shock.

Quantitative analysis of left ventricular chamber enhancement, diameter of the great vessels, and spleen and renal medulla enhancement on multi-phasic whole body MDCT scans may identify polytrauma patients at risk of death.

Tso, D, Wang, J, McLaughlin, P, Nicolaou, S, Predicting Mortality from Hypovolemic Shock Complex in the Polytrauma Setting.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14007018.html