title: "Blush" on trauma computed tomography: not as bad as we think!
abstract: BACKGROUND
  Intravenous contrast extravasation (IVCE) on a trauma computed tomography has been quoted as a reason for intervention (angiographic embolization or operation). The new-generation computed tomographic (CT) scanners identify IVCE with increasing frequency. We hypothesized that most IVCEs do not require an intervention.
  
  
  METHODS
  This study was a retrospective evaluation of trauma patients with IVCE on abdomen or pelvis CT scan (January 2005-December 2009). Along with demographic and hemodynamic variables, the following characteristics of IVCE were examined as potential risk factors for intervention: maximal dimension, small (≤ 1.5 cm) versus large (>1.5 cm), contained versus free, and single versus multiple and location.
  
  
  RESULTS
  Sixty-nine patients with 81 IVCEs were identified: 48 IVCEs occurred in intra-abdominal solid organs, 18 IVCEs in the pelvic retroperitoneal space, and 15 IVCEs in the soft tissues or other locations. Thirty patients (43.5%) were managed without an intervention, and 39 patients (56.5%) required either an immediate (30 patients) or a delayed (9 patients) intervention. Multivariate analysis identified three independent predictors of an intervention: an admission systolic blood pressure of 100 mm Hg or lower, a large ICVE, and an Abbreviated Injury Score of the abdomen of 3 or higher. If all three independent predictors were present, 100% of patients received an intervention.
  
  
  CONCLUSIONS
  Nearly half of IVCEs on CT scan did not require an intervention. A hypotension at admission, a severe abdominal trauma, and a blush diameter of 1.5 cm or greater predicted the need for intervention.
  
  
  METHODS
  Therapeutic study, level IV; prognostic study, level III.
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care and the Department of Biostatistics and Epidemiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Michailidou
authors.forename: George C
authors.initials: GC
authors.lastname: Velmahos
authors.forename: Gwendolyn M
authors.initials: GM
authors.lastname: van der Wilden
authors.forename: Gwen
authors.initials: G
authors.lastname: van der Wilden
authors.forename: Hasan B
authors.initials: HB
authors.lastname: Alam
authors.forename: Marc
authors.initials: M
authors.lastname: de Moya
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D003287:Contrast Media / Q000009:adverse effects*; D005069:Evaluation Studies as Topic; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000009:adverse effects* / Q000706:statistics & numerical data; D014193:Trauma Centers; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014481:United States; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology
chemical_list: D003287:Contrast Media