Dan Salyer MD, Jack Protetch BA, C. Michael Dunham MD*, John Porter MD*, Laurel Omert MD* Department of Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania and St. Elizabeth Hospital, Youngstown, Ohio.

Objective: Numerous studies have attempted to correlate the grade of splenic injury demonstrated by computed tomography (CT) with the ability to non-operatively manage blunt trauma patients, but there are no absolute indicators which guarantee success. The "contrast blush" (CB) CT finding which indicates extravasation of intravenous dye from an actively bleeding arterial or venous source has often been used clinically as an indicator of need for a therapeutic splenic intervention (SI) (splenectomy, splenorrhaphy or angiographic-embolization). We sought to examine the prognostic significance of this finding.

Methods: The records 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. Identification of "contrast blush" patients was obtained by reading CT reports of patients reported as having splenic injuries by the trauma registries at the two institutions over a five year period, as well as by personally reviewing the CT scans of all patients with Grade Ill or higher injuries. Results: A CB was identified in 37 patients (11%) compared to the final radiology report which described the finding in 6%. The additional scans were re-reviewed by a radiology attending who concurred with our reading. The mean age of those who had a splenic intervention (SI) performed was 40.1+20.2 while those who were observed had a mean age of 33.8+18.2 years. The chance of having SI was greater in those with CB (75.0%) when compared to thos&without CB (24.7%); (p«0.0001, odds ratio = 9.2). CB was related to the grade of injury (p«0.0001):

Grade I/Il - 3.2%, Grade Ill - 11.8%, Grade IVN - 26.3%. SI was also related to the grade (p«O.OOOI): Grade I/Il - 7.4%, Grade Ill - 37.6% and Grade IVN - 69.7%. The chance of having SI was greater for those who arrived in the ED with a blood pressure <100 mm Hg (58.4%) compared to normotensive individuals (23.5%) (p«0.0001). Finally, we performed a multivariate logistic regression analysis which revealed that SI correlated independently with splenic grade, ED hypotension, and age but did not demonstrate a correlation with CB.

Conclusions: The presence of a spleen "contrast blush" on CT of the abdomen 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.



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