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Does Having a "Blush" on CT With Splenic or Hepatic Injury From Blunt Abdominal Trauma Necessitate an Invasive Intervention?
Matthew T. Santore, MD and Martha E. Ingram, Children's Healthcare of Atlanta, Atlanta GA

Abstract:
The guidelines for management of blunt abdominal trauma with contrast extravasation ("blush") in pediatric trauma remains inconclusive. We report our experience as a level I pediatric trauma center in managing cases with hepatic and splenic blush. All cases of pediatric blunt abdominal trauma resulting in liver or splenic injury were queried from 2008-2012 records. Patients were excluded if a CT was unavailable in the medical record. The presence of contrast blush was based on finding descriptions using "contrast extravasation" or "blush" within final reports from attending pediatric radiologists. Correlations between incidence of contrast blush and major outcomes of interest were determined using Fisher's Exact Test, evaluating statistical significance at p< 0.05. Of 219 patients, we report 9 cases of hepatic blush and 3 cases of splenic blush. Blush occurred more frequently in older patients (10-14 years; p=0.29) and was associated with higher grades (IV, V) of injury (p=0.002). Patients with contrast blush on imaging were more likely to be admitted to the ICU (100% vs. 51%), and more likely to receive blood products (75% vs. 18%, p=0.0006). The finding of blush had no significant correlation with whether patients received operative management, interventional radiology treatment (p=0.15) nor overall survival (p=0.26). The finding of a blush on CT from a splenic or liver injury is associated with higher grades of injury, and requires intensive medical management, but does not always dictate a need for invasive intervention. From the limited data it can be suggested that a blush can be managed non-operatively.
Objective:
To determine if having a splenic or liver blush on CT from blunt abdominal trauma necessitates an invasive intervention.
Objective Content: The finding of a blush on CT from a splenic or liver injury is associated with higher grades of injury, and requires intensive medical management, but does not always dictate a need for invasive intervention.


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