The use of contrast enhanced thoraco-abdominal CT in patients with non-traumatic undifferentiated hemodynamic shock.

OBJECTIVE: To assess the role of thoraco-abdominal computed tomography (CT) in patients with undifferentiated shock in the emergency department (ED). Secondary aim was to assess common etiologies for undifferentiated shock.

METHODS: This was a single-center, retrospective study evaluating patients with undifferentiated shock who underwent a dedicated "shock protocol" CT in the ED. CT included a non-contrast thoraco-abdominal scan followed by arterial thoraco-abdominal and abdominal portal phases. Patients' clinical records, laboratory, imaging data and all-cause 90-days mortality were collected. Patients' shock category (i.e., distributive, cardiogenic, hypovolemic, obstructive, multifactorial, and unknown) and etiology for shock were retrospectively determined based on patients' medical records. Effect of CT on patients' diagnosis and management was assessed based on physicians' reports before and after CT.

RESULTS: Overall, 102 patients were scanned between December 2018 and December 2020. Distributive shock was the most prevalent type with 47.1% of all patients (48/102), followed by hypovolemic shock (17/102, 16.7%). Based on clinical data and CT reports, shock etiology was diagnosed for 89.2% (91/102) patients. Sepsis was the most common etiology in 50% of patients, followed by non-traumatic hemorrhage (15/102, 14.7%). Overall, 90-day mortality was 58.8%. Shock protocol CT led to change in differential diagnosis in 49% of patients and to change in management in 42.2%.

CONCLUSION: Contrast-enhanced shock protocol CT can help in shock differentiation, assessment of etiology and in management of patients presenting to the ED with undifferentiated shock.