Venous Phase Diameter Of Inferior Venacava On Computed Tomography- A Predictor Of Hypotension In Blunt Abdominal Trauma -One Year Hospital Based Observational Study

Abstract

INTRODUCTION: Blunt abdominal trauma is one of the important contributors to morbidity and mortality. Studies have indicated that the incidence of blunt abdominal trauma has been increasing in the past decade. Since the burden of blunt abdominal trauma is more in Low- and Middle-income countries such as India, it calls for the development of various rapid diagnostic modalities to aid in early diagnosis, for faster initiation of treatment and for reducing the preventable mortality. AIMS & OBJECTIVES: The current study was aimed at assessing the diameter of IVC on the axial section of the CT scan of the abdomen as a predictor of hypotension in blunt abdominal trauma. MATERIALS & METHODS: The current study was a cross sectional study, conducted in the department of Radiodiagnosis at KLE’s Dr.Prabhakar Kore Hospital & MRC, Belagavi. A total of 30 blunt abdominal trauma patients affected by blunt abdominal trauma were included by universal sampling method. Transverse: Anteroposterior ratio of the IVC was measured infrarenally. The normal cut off value of ratio was considered as 1.9. We considered a ratio of > or = 1.9 as flat IVC and that <1.9 -as non- flat IVC. The sensitivity, specificity and predictive values of flat IVC in detecting hypotension were assessed by using IBM SPSS statistical software. RESULTS: This study included 30 subjects with a history of blunt abdominal injury with a mean age of 26.93 ± 11.51 years for analysis. Majority of subjects were in the age group of 21 to 40 years. There was a significant male preponderance as 83.3% of the study subjects were men. All the 30 patients involvement of the solid organs, among whom 16(53.3%) had splenic injury, 15(50%) had liver injury, 4(13.3%) had pancreatic injury and 5(16.7%) had kidney injury. Among the splenic injury patients, major proportion were grade III(37.5%) and grade IV (37.5%) injuries. The percentage of Grade II and Grade III (n=5, 33.33% each) injuries were higher among liver injury patients. The percentage of grade III (n=2,50%) injury was greater among patients with pancreatic injury compared to Grades II and IV (n=1, 25% each). Whereas, the percentage of grade I and II (n=2, 40% each) injuries was equal among patients with kidney involvement. Among the study population 23(76.7%) had flat IVC 28(93.3%) had hypotension and 23(76.7%) had both hypotension and flat IVC. Flat IVC had sensitivity of 82.14% (95% CI 63.11% to 93.94%), specificity of 100.00% (95 CI 15.81% to 100%) in detecting hypotension. The positive predictive value was 100.00% (95 CI 85.18% to 100%), Negative predictive value was 28.57% (95 CI 3.67%to 70.96%), and the total diagnostic accuracy was 83.33% (95 CI 65.28%to 94.36%). CONCLUSIONS: Flat IVC on CT could be of value in predicting hypotension among blunt abdominal trauma patients. Perhaps, this finding could serve the treating physician as an aid in early diagnosis and management to prevent mortality in such patients.