title: Abdominopelvic hemorrhage: correlation of CT positivity with the subsequent decision to perform blood transfusion.
abstract: The purpose of this study is to determine the role of computed tomography (CT) on the decision to administer blood transfusions in patients with abdominopelvic hemorrhage (trauma, surgery, invasive procedure, and spontaneous) and to determine the clinical parameters most likely to influence the decision to administer blood transfusions in patients with spontaneous abdominopelvic hemorrhage. In this IRB approved and HIPPA compliant study, retrospective analysis was performed on 298 patients undergoing abdominal and pelvic CT for suspected abdominopelvic hemorrhage and the CT reports and electronic medical records were reviewed. Odds ratios and 95% CI were calculated to compare the odds of abdominopelvic hemorrhage and transfusion for categorical and continuous predictors. The presence of abdominopelvic hemorrhage by CT was significantly associated with blood transfusions for trauma patients (p-value <0.0001) only. 106 patients with suspected spontaneous abdominopelvic hemorrhage had the lowest CT positivity rate (n = 23, 21.7%) but the highest blood transfusion rate (n = 62, 58.5%) compared to the patients with abdominopelvic hemorrhage from known preceding causes. In patients with spontaneous abdominopelvic hemorrhage, low hemoglobin and hematocrit levels immediately prior to obtaining the CT study were more predictive for receiving a blood transfusion (p-value <0.0001) than the presence of hemorrhage by CT. CT positivity is strongly correlated with the decision to administer blood transfusions for patients with abdominopelvic hemorrhage from trauma, indicating that CT studies play a significant role in determining the clinical management of trauma patients. For patients with spontaneous abdominopelvic hemorrhage, the decision to transfuse depends not on the CT study but on the patient's hemoglobin and hematocrit levels. CT studies should therefore not be performed for the sole purpose of determining the need for blood transfusion in patients with spontaneous abdominopelvic hemorrhage.
authors.affiliation: Department of Radiology, University of Michigan Medical Center, 1500 E. Medical Center Drive, TC-B1-140D, SPC 5302, Ann Arbor, MI, 48109-5302, USA. suzchong@med.umich.edu.
authors.forename: Suzanne T
authors.initials: ST
authors.lastname: Chong
authors.affiliation: Department of Radiology, University of Michigan Medical Center, 1500 E. Medical Center Drive, TC-B1-140D, SPC 5302, Ann Arbor, MI, 48109-5302, USA.
authors.forename: James H
authors.initials: JH
authors.lastname: Ellis
authors.affiliation: Department of Radiology, University of Michigan Medical Center, 1500 E. Medical Center Drive, TC-B1-140D, SPC 5302, Ann Arbor, MI, 48109-5302, USA.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Cohan
authors.affiliation: Department of Radiology, University of Michigan Medical Center, 1500 E. Medical Center Drive, TC-B1-140D, SPC 5302, Ann Arbor, MI, 48109-5302, USA.
authors.forename: Ursula S
authors.initials: US
authors.lastname: Knoepp
authors.affiliation: Department of Radiology, Emory University, Atlanta, GA, 30322, USA.
authors.forename: Travis J
authors.initials: TJ
authors.lastname: Langley
authors.affiliation: Department of Neurosurgery, University of San Francisco, San Francisco, CA, 94110, USA.
authors.forename: Darryl
authors.initials: D
authors.lastname: Lau
authors.affiliation: Michigan Institute for Clinical and Health Research (MICHR), University of Michigan Medical Center, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
authors.forename: Shokoufeh
authors.initials: S
authors.lastname: Khalatbari
mesh_terms: D000005:Abdomen; D001803:Blood Transfusion; D006470:Hemorrhage / Q000000981:diagnostic imaging*; D006801:Humans; D010388:Pelvis / Q000000981:diagnostic imaging*; D011860:Radiography, Abdominal; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: Abdominopelvic; Anticoagulation; CT; Hemorrhage; Transfusion