Initial assessment of hemorrhagic shock by trauma computed tomography measurement of the inferior vena cava in blunt trauma patients

Abstract

Purpose: Inferior vena cava (IVC) collapse is related to hypovolemia. Sonography has been used to measure the IVC diameter, but there is variation depending on the skill of the operator and it is difficult to obtain accurate measurements in patients who have a large amount of intestinal gas or are obese. As a modality to obtain accurate measurements, we measured the diameters of the IVC and aorta on trauma computed tomography scans and investigated the correlation between the IVC to aorta ratio and the shock index in blunt trauma patients.Methods: We retrospectively analyzed the medical records of 588 trauma patients who were transferred to the regional trauma center (level 1) of Wonkang University hospital from March 2020 to February 2021. We included trauma patients 18 years or older who met the trauma activation criteria and underwent trauma computed tomography scans with intravenous contrast within 40 minutes of admission. The shock index was calculated from vital signs before trauma computed tomography scan, and measurements of the anteroposterior diameter of the IVC (AP), the transverse diameter of the IVC (T), and aorta were made 10 mm above the right renal vein in the venous phase.Results: Overall, 271 patients were included in this study, of whom 150 had a shock index ≤0.7 and 121 had a shock index >0.7. The T to AP ratio and AP to aorta ratio were significantly different between groups. Cutoffs were identified for the T to AP ratio and AP to aorta ratio (2.37 and 0.62, respectively) that produced clinically useful sensitivity and specificity for predicting a shock index >0.7, demonstrating moderate accuracy (T to AP ratio: area under the curve, 0.71; sensitivity, 59%; specificity, 87% and AP to aorta ratio: area under the curve, 0.70; sensitivity, 55%; specificity, 91%).Conclusions: The T to AP ratio and AP to aorta ratio are useful for predicting hemorrhagic shock in trauma patients.