title: Predictive value of a flat inferior vena cava on initial computed tomography for hemodynamic deterioration in patients with blunt torso trauma.
abstract: BACKGROUND
  We aimed to investigate the value of the diameter of the inferior vena cava (IVC) on initial computed tomography (CT) to predict hemodynamic deterioration in patients with blunt torso trauma.
  
  
  METHODS
  We reviewed the initial CT scans, taken after admission to emergency room (ER), of 114 patients with blunt torso trauma who were consecutively admitted during a 24-month period. We measured the maximal anteroposterior and transverse diameters of the IVC at the level of the renal vein. Flat vena cava (FVC) was defined as a maximal transverse to anteroposterior ratio of less than 4:1. According to the hemodynamic status, the patients were categorized into three groups. Patients with hemodynamic deterioration after the CT scans were defined as group D (n = 37). The other patients who remained hemodynamically stable after the CT scans were divided into two groups: patients who were hemodynamically stable on ER arrival were defined as group S (n = 60) and those who were in shock on ER arrival and responded to the fluid resuscitation were defined as group R (n = 17).
  
  
  RESULTS
  The anteroposterior diameter of the IVC in group D was significantly smaller than those in groups R and S (7.6 mm ± 4.4 mm, 15.8 mm ± 5.5 mm, and 15.3 mm ± 4.2 mm, respectively; p < 0.05). Of the 93 patients without FVC, 16 (17%) were in group D, 14 (15%) required blood transfusion, and 8 (9%) required intervention. However, of the 21 patients with FVC, all patients were in group D, 20 (95%) required blood transfusion, and 17 (80%) required intervention. The patients with FVC had higher mortality (52%) than the other patients (2%).
  
  
  CONCLUSIONS
  In cases of blunt torso trauma, patients with FVC on initial CT may exhibit hemodynamic deterioration, necessitating early blood transfusion and therapeutic intervention.
authors.affiliation: Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan. m-shokei@feel.ocn.ne.jp
authors.forename: Shokei
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Sekine
authors.forename: Motoyasu
authors.initials: M
authors.lastname: Yamazaki
authors.forename: Kenihiro
authors.initials: K
authors.lastname: Sasao
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Funabiki
authors.forename: Masayuki
authors.initials: M
authors.lastname: Shimizu
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshii
authors.forename: Masanobu
authors.initials: M
authors.lastname: Kishikawa
authors.forename: Mitsuhide
authors.initials: M
authors.lastname: Kitano
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D000704:Analysis of Variance; D001803:Blood Transfusion; D003287:Contrast Media; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D015601:Injury Severity Score; D007472:Iohexol; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013898:Thoracic Injuries / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000628:therapy
chemical_list: D003287:Contrast Media; D007472:Iohexol