Morihiro Katsura1, Shingo Fukuma2, Akira Kuriyama3, Tadaaki Takada4, Yasuhiro Ueda5, Shima Asano6, Yutaka Kondo7, Masafumi Ie8, Kazuhide Matsushima9, Takahiro Murakami10, Yoshimitsu Fukuzato11, Nobuhiro Osaki12, Hidemitsu Mototake13, Shunichi Fukuhara14. 1. Department of General Surgery, Okinawa, Chubu Hospital, Okinawa, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan. Electronic address: morihiro@bj8.so-net.ne.jp. 2. Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan. Electronic address: fukuma.shingo.3m@kyoto-u.ac.jp. 3. Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan. Electronic address: akira.kuriyama.jpn@gmail.com. 4. Department of Emergency and Critical Care Medicine, Tokushima, Red Cross Hospital, Tokushima, Japan. Electronic address: acky.takada@gmail.com. 5. Tajima Emergency and Critical Care Medical Center, Toyooka, Public Hospital, Hyogo, Japan. Electronic address: iryou.shimodamu@gmail.com. 6. Department of Surgery, Okinawa, Miyako Hospital, Okinawa, Japan. Electronic address: shimappe@me.com. 7. Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan; Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba, Japan. Electronic address: kondokondou2000@yahoo.co.jp. 8. Department of General Surgery, Okinawa, Chubu Hospital, Okinawa, Japan. Electronic address: iemasafumi1201@yahoo.co.jp. 9. Division of Acute Care Surgery, University of Southern California, Los Angeles, California, USA. Electronic address: kazuhide.matsushima@med.usc.edu. 10. Department of General Surgery, Okinawa, Chubu Hospital, Okinawa, Japan. Electronic address: murakami_takahiro@hosp.pref.okinawa.jp. 11. Department of Pediatric Surgery, Okinawa, Nanbu Medical Center & Children's Medical Center, Okinawa, Japan. Electronic address: fukuzato_yoshimitsu@hosp.pref.okinawa.jp. 12. Department of Surgery, Okinawa, Yaeyama Hospital, Okinawa, Japan. Electronic address: osaki_nobuhiro@hosp.pref.okinawa.jp. 13. Department of General Surgery, Okinawa, Chubu Hospital, Okinawa, Japan. Electronic address: mototake_hidemitsu@hosp.pref.okinawa.jp. 14. Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan. Electronic address: fukuhara.shunichi.6m@kyoto-u.ac.jp.
Abstract
PURPOSE: We aimed to examine the association between contrast extravasation (CE) on initial computed tomography (CT) scan and pseudoaneurysm (PSA) development in pediatric blunt splenic and/or liver injury. METHODS: We conducted a multi-institutional retrospective study in cases of blunt splenic and/or hepatic injury who underwent an initial attempt of nonoperative management. A logistic regression model was used to compare PSA formation and CE on initial CT scan, and the area under the receiver operating characteristic curve (AUC) with and without CE was used to assess the predictive performance of CE for PSA formation. RESULTS: Of 236 cases enrolled from 10 institutions, PSA formation was observed in 17 (7.2%). Multivariate analysis showed a significant association between CE on initial CT scan and increased incidence of PSA formation (odds ratio, 4.96; 95% confidence interval, 1.37-18.0). There was no statistically significant association between the grade of injury and PSA formation. The AUC improved from 0.75 (0.64-0.87) to 0.80 (0.70-0.91) with CE. CONCLUSION: Active CE on initial CT scan was an independent predictor of PSA formation. Selective use of follow-up CT in children who showed CE on initial CT may provide early identification of PSA formation, regardless of injury grade. LEVEL OF EVIDENCE: Prognostic and epidemiological, level III.
PURPOSE: We aimed to examine the association between contrast extravasation (CE) on initial computed tomography (CT) scan and pseudoaneurysm (PSA) development in pediatric blunt splenic and/or liver injury. METHODS: We conducted a multi-institutional retrospective study in cases of blunt splenic and/or hepatic injury who underwent an initial attempt of nonoperative management. A logistic regression model was used to compare PSA formation and CE on initial CT scan, and the area under the receiver operating characteristic curve (AUC) with and without CE was used to assess the predictive performance of CE for PSA formation. RESULTS: Of 236 cases enrolled from 10 institutions, PSA formation was observed in 17 (7.2%). Multivariate analysis showed a significant association between CE on initial CT scan and increased incidence of PSA formation (odds ratio, 4.96; 95% confidence interval, 1.37-18.0). There was no statistically significant association between the grade of injury and PSA formation. The AUC improved from 0.75 (0.64-0.87) to 0.80 (0.70-0.91) with CE. CONCLUSION: Active CE on initial CT scan was an independent predictor of PSA formation. Selective use of follow-up CT in children who showed CE on initial CT may provide early identification of PSA formation, regardless of injury grade. LEVEL OF EVIDENCE: Prognostic and epidemiological, level III.
Authors: Federico Coccolini; Raul Coimbra; Carlos Ordonez; Yoram Kluger; Felipe Vega; Ernest E Moore; Walt Biffl; Andrew Peitzman; Tal Horer; Fikri M Abu-Zidan; Massimo Sartelli; Gustavo P Fraga; Enrico Cicuttin; Luca Ansaloni; Michael W Parra; Mauricio Millán; Nicola DeAngelis; Kenji Inaba; George Velmahos; Ron Maier; Vladimir Khokha; Boris Sakakushev; Goran Augustin; Salomone di Saverio; Emanuil Pikoulis; Mircea Chirica; Viktor Reva; Ari Leppaniemi; Vassil Manchev; Massimo Chiarugi; Dimitrios Damaskos; Dieter Weber; Neil Parry; Zaza Demetrashvili; Ian Civil; Lena Napolitano; Davide Corbella; Fausto Catena Journal: World J Emerg Surg Date: 2020-03-30 Impact factor: 5.469