Active hemorrhage in children after thoracoabdominal trauma: clinical and CT features.

OBJECTIVE: We reviewed the clinical features and CT evidence of active hemorrhage in children undergoing CT studies because of closed thoracoabdominal trauma. Our purpose was to evaluate the hypothesis that children with this CT finding have uniformly poor clinical outcomes.

MATERIALS AND METHODS: The CT records of approximately 3000 children undergoing CT evaluation for trauma at four geographically distinct pediatric trauma centers were reviewed for the presence of active hemorrhage on CT scans. The location and severity of active hemorrhage, accompanying organ injury, initial clinical information, type of treatment (surgical or nonsurgical), and clinical outcome were recorded.

RESULTS: Seven CT studies showing acute extravasation of intravascular contrast material in the abdomen (six) or chest (one) were identified. Hemorrhage was caused by severe solid organ injury in four children (three with hepatic injury and one with splenic injury) and by vascular injury to the internal iliac artery, segmental pulmonary artery, and descending colon in one child each. Every child with abdominal injuries had large collections of intraperitoneal fluid, and three children had abdominal CT signs of hypoperfusion. Although all patients were hemodynamically stable initially, four children became hypotensive during CT examination. Six children required surgical intervention because of ongoing blood loss, and two children died.

CONCLUSION: Our results suggest that children with CT evidence of active hemorrhage have a different spectrum of injuries than that seen in adults. Despite the high rate of hemodynamic instability and need for urgent surgical intervention, most children with this CT finding survive.