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Why is this important?
- Blunt chest trauma is associated with high mortality.
- Blush is extravasation of intravascular contrast material on CT and signals active bleeding.
- Bleeding frequently occurs within the airways and can affect breathing, even if the volume of bleeding is small.
- In the context of hepatic and splenic trauma, the presence of a blush signals the need for intervention.
- Less is known regarding blush in the context of pulmonary trauma.
Principle results
- 13 patients (16%) had a blush, and 7 died.
- Comparison between the presence and absence of a blush:
- In-hospital mortality rate: 53% vs. 10%; P<0.001.
- Placement on artificial ventilation: 100% versus 64%; P<0.001.
- Number of ventilator-free days: 0 versus 25 days; P=0.001.
- The most common cause of death in patients with blush was intrathoracic bleeding, including secondary respiratory failure.
Methodology
- A single-center observational study focused on trauma patients presenting to the emergency department (ED; n = 83).
- All patients had injury severity scores of 16 or greater, chest abbreviated injury scale scores of 3 or greater, and severe pulmonary contusions of 5 cm or greater.
- All had undergone a CT scan with the use of a contrast product on their arrival.
- Endpoints: in-hospital mortality, number of ventilator-free days, interventions.
- Funding: no funding has been communicated.
Limits
- The ED protocol on patient selection for CT with contrast was not described, posing the risk of selection bias.
- Small retrospective study.
