What is the significance of contrast "blush" in pediatric blunt splenic trauma?
OBJECTIVE
Contrast extravasation (CE) associated with blunt splenic injuries (BSIs) in adults is commonly treated with embolization or splenectomy. Whether this is necessary in children is unclear. We sought to determine if CE on initial computed tomography (CT) is associated with negative outcomes in children with BSI.


METHODS
Blunt splenic injuries presented to our pediatric trauma center between January 21, 1999, and December 31, 2006, were reviewed (minimum follow-up = 2 years). Those with initial CTs available were reviewed by a pediatric radiologist blinded to outcomes. Descriptive analysis and multivariable logistic regression were performed using Stata S/E 10.0 (Stata Corporation, College Station, Tex).


RESULTS
One hundred eighty-two BSIs were treated at our center. One hundred twenty-three had available CTs (mean age, 10.7 years; male, 70.7%; mean Injury Severity Score, 17; median injury grade, 3; transfusion rate, 13.8%; overall mortality, 2.44%). Those with associated injuries comprised 47.1%. No splenectomies or splenorrhaphies were performed. One delayed splenic bleed occurred. Eight patients (6.5%) had CE on initial CT. Multivariable logistic regression controlling for multiple injuries found no association between CE and the need for transfusion, mortality, delayed splenic bleeding, length of hospitalization, or splenectomy. Contrast extravasation was positively associated with low initial and lowest hemoglobin levels (<90 g/L) (odds ratio [OR], 6.45; 95% confidence interval [CI], 1.00-39.47; P = .044 and OR, 5.63; 95% CI, 1.20-26.49; P = .029), respectively.


CONCLUSIONS
Contrast extravasation occurred in 6.5% of our pediatric patients with BSIs. The presence of contrast "blush" on abdominal CT was not associated with negative outcomes after a minimum of 2 years of follow-up. Pediatric patients with CE can be treated without surgery and can be managed using the standard American Pediatric Surgical Association guidelines.
Davies
Dafydd A
DA
Department of Pediatric Surgery, The Hospital for Sick Children, Toronto, Canada M5G 1X8.
Ein
Sigmund H
SH
Pearl
Richard
R
Langer
Jacob C
JC
Traubici
Jeff
J
Mikrogianakis
Angelo
A
Wales
Paul W
PW
D001803:Blood Transfusion; D002648:Child; D005119:Extravasation of Diagnostic and Therapeutic Materials; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D016037:Single-Blind Method; D013154:Spleen / Q000098:blood supply / Q000293:injuries*; D013157:Splenic Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000145:classification / Q000000981:diagnostic imaging* / Q000628:therapy