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Emergency Radiology

E3315. Abdominal CT Findings, Cause of Death in 32 Patients Who Died 24 Hours of Arrival to Emergency Room

Maristany M,  Danrad R,  Murphy L,  Greiffenstein P. Louisiana State University Health Sciences Center, New Orleans, LA

Address correspondence to M. Maristany (mmaris@lsuhsc.edu)

Objective: The purpose of the study is to correlate CT findings and cause of death in patients with trauma who received a CT scan of the abdomen and pelvis upon arrival to the emergency room and died within 24 hours.

Materials and Methods: A sample of 32 patients who received a CT scan of the abdomen and pelvis on arrival to the emergency room and who died within 24 hours was obtained. Each study was reviewed and the likely cause of death determined. Correlations were made using the shock scale and subjective findings of the potential death.

Results: Three categories of patients were found. The first category was patients with major abdominal or pelvic trauma with large amount of hemorrhage. These patients had a high shock score and subjectively, the potential for death of these patients was realized in a timely fashion. The second category was patients with head trauma that did not have significant trauma in the abdomen or pelvis. These patients generally had mixed shock scores and were clinically identified as having high likelihood of death. The third category was patients with little evidence of hemorrhage on CT of the abdomen and pelvis and no evident head trauma and low expectation of death. This was the smallest group, but most important for radiologist to identify so the medical team can be alerted immediately. The most helpful finding for this group is the lack of excretion from the kidneys on 5-minute delayed images. The lack of excretion of contrast from the kidneys was highly predictive of impending death.

Conclusion: Our trauma team categorizes trauma into two major categories, blunt trauma and penetrating trauma. As radiologists, we should consider a subcategory that falls within these categories – trauma patients that demonstrate life-threatening findings on CT that might not otherwise be identified without deliberate evaluation. Urinary excretion on delayed images is easily identified, almost in a binary sense, and correlates very highly with impending coding or death. By identifying this finding and communicating its importance in a rapid manner, the lives of patients can be saved.