Implications of the "contrast blush" finding on computed tomographic scan of the spleen in trauma.

BACKGROUND: The "contrast blush" (CB) computed tomographic (CT) scan finding has often been used clinically as an indicator for therapeutic splenic intervention (SI) (splenectomy, splenorrhaphy, or angiographic embolization). We sought to examine the prognostic significance of this finding.

METHODS: The records and CT scans of 324 trauma patients from two Level I trauma centers who had blunt splenic injury and a CT scan of the abdomen within 24 hours of admission were reviewed and screened for CB.

RESULTS: CB was identified in 11% of patients, and its incidence was significantly related to the grade of injury: grade I/II, 3.2%; grade III, 11.8%; and grade IV/V, 26.3% (p < 0.001). SI was also related to the grade: grade I/II, 7.7%; grade III, 37.6%; and grade IV/V, 69.7% (p < 0.001). The chance of having SI was greater in those with CB (75.0%) when compared with those without CB (25.0%) (p < 0.001; odds ratio, 9.2). A multivariate logistic regression analysis revealed that SI correlated independently with splenic grade, emergency department hypotension, and age, but did not demonstrate a correlation with CB.

CONCLUSION: CB is not an absolute indication for an operative or angiographic intervention. Factors such as patient age, grade of injury, and presence of hypotension need to be considered in the clinical management of these patients.