What is the significance of contrast "blush" in pediatric blunt splenic trauma?

Dafydd A Davies, Sigmund H Ein, Richard Pearl, Jacob C Langer, Jeff Traubici, Angelo Mikrogianakis, Paul W Wales
Journal of Pediatric Surgery 2010, 45 (5): 916-20

PURPOSE: 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.

CONCLUSION: 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.

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