Inferior vena cava size is not associated with shock following injury

Radomski, Michael; Agnihothri, Ritesh; Knapp, Stephanie; Scher, David M.; Khati, Nadia J.; Brindle, Kathleen A.; Amdur, Richard L.; Messing, Jonathan; Dunne, James R.; Sarani, Babak

doi:10.1097/ta.0000000000000248

Cited by 10 publications

(19 citation statements)

References 7 publications

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“…Paediatric trauma patients in the present cohort who went on to develop shock in the first 24 hours had a significantly flatter IVC on admission CT than those who remained normotensive. The present results are in keeping with findings from the adult literature, which is predominantly in support of IVC calibre as a useful independent predictor of patient outcome 8e12 with only a couple of studies finding IVC calibre unhelpful 14,15 ; although it should be noted that one of these studies was only looking at haemodynamically normal patients.…”

Section: Discussionsupporting

confidence: 91%

Inferior vena cava calibre on paediatric trauma CT may be a useful predictor for the development of shock

2016

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IVC calibre was found to be a more useful predictor of shock than heart rate or blood pressure, and may, therefore, prove to be a useful predictor of impending haemodynamic instability in children as it is in adults. Although the study was carried out at a busy unit, the numbers are acknowledged to be small and a larger study would be needed to validate these findings and identify whether there is any variation in the CT appearances between different age groups.

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Section: Discussionsupporting

confidence: 91%

Inferior vena cava calibre on paediatric trauma CT may be a useful predictor for the development of shock

2016

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“…However, one study has found that a flat IVC might not be associated with shock status in patients with moderate injury compared with the population in the present study (ISS score: 14 vs 16.4 and SI: 0.67 vs 0.90). 8 Milia et al 6 have found that age is another modifier and that shock is not significantly correlated to a flat IVC among patients aged >55 years. Nonetheless, the performance of the IVC ratio in this study did not change before and after adjusting for confounders, such as age (Table 2).…”

Section: Discussionmentioning

confidence: 98%

“…3,7 However, other scholars have found that either a flat IVC in elderly individuals 6 or the static degree of IVC collapse among patients with minor injuries is not associated with shock. 8 Furthermore, other studies have reported that IVC flatness on CT scan is not a valid indicator of lactic acidosis in patients with trauma who have normal hemodynamic findings. 9 The present study aims to identify another method and subpopulation that can be used to evaluate the prediction performance of IVC size accurately.…”

Section: Introductionmentioning

confidence: 98%

“…Previous studies have calculated the ratio of the transverse diameter to the anteroposterior diameter (T/AP) of IVC by obtaining 1 or 2 slices of axial CT scan. 3,6,8 However, the IVC ratio could vary at different levels. We recorded a specific segment of the IVC and calculated its volume to minimize the influence of the variable IVC ratio at different levels.…”

Section: Introductionmentioning

confidence: 99%

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Inferior Vena Cava Volume Is an Independent Predictor of Massive Transfusion in Patients With Trauma

Chien

Yan

Han

et al. 2019

J Intensive Care Med

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Objectives: Early adequate resuscitation of patients with trauma is crucial in preventing shock and early mortality. Thus, we aimed to determine the performance of the inferior vena cava (IVC) volume and other risk factors and scores in predicting massive transfusion and mortality. Methods: We included all patients with trauma who underwent computed tomography (CT) scan of the torso, which included the abdominal area, in our emergency department (ED) from January 2014 to January 2017. We calculated the 3-dimensional IVC volume from the left renal vein to the IVC bifurcation. The primary outcome was the performance of IVC volume in predicting massive transfusion, and the secondary outcome was the performance of IVC volume in predicting 24-hour and 30-day in-hospital mortality. Results: Among the 236 patients with trauma, 7.6% received massive transfusions. The IVC volume and revised trauma score (RTS) were independent predictors of massive transfusion (adjusted odds ratio [OR]: 0.79 vs 1.86, 95% confidence interval [CI], 0.71-0.89 vs 1.4-2.47, respectively). Both parameters showed the good area under the curve (AUC) for the prediction of massive transfusion (adjusted AUC: 0.83 and 0.82, 95% CI, 0.74-0.92 vs 0.72-0.93, respectively). Patients with a large IVC volume (fourth quartile) were less likely to receive massive transfusion than those with a small IVC volume (first quartile, ≥28.29 mL: 0% vs <15.08 mL: 20.3%, OR: 0.13, 95% CI, 0.03-0.66). Conclusions: The volume of IVC measured on CT scan and RTS are independent predictors of massive transfusion in patients with trauma in the ED.

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“…Correlat on between pat ents' IVC flatness ndex and shock ndex, Glasgow Coma Score, Injury Sever ty Score, lactate level and base def c t Correlat on Coeff c ent patients 23. In our study, first admission base deficit was found to be worse in flat IVC patients than non-flat IVC patients.Nguyen et al and Liao et al found in their studies that resuscitation of flattened IVC patients required significantly higher amounts of crystalloids and blood products compared to non-flattened IVC patients.17,22 Matsumoto et al in their study with blunt torso trauma patients that flat IVC is an indication of hemodynamic deterioration and requires early blood transfusion in trauma patients.6 On the other hand, Radomski et al, in their study with blunt trauma patients, stated that IVC size in trauma patients was not associated with emergency transfusion 4. In our study, a volume replacement was observed to be higher within 24 hours of clinical outcome in patients with flat IVC.…”

mentioning

confidence: 99%

The Role of Flatness Index of Inferior Vena Cava in Early Hypovolemic Shock Concerning Blunt Torso Trauma Patients

Kavak

ERTAN

Seki

et al. 2022

Ankara Eğitim Ve Araştırma Hastanesi Tıp Dergisi

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AIM: Our aim is to evaluate the role of flatness of index of Inferior Vena Cava (IVC) with early hypovolemic shock in blunt torso trauma patients. MATERIAL AND METHOD: In the computed tomography (CT) scan, patients with flatness index below 2 were considered as flat IVC patients, and those with 2 or more were considered as non-flattened IVC patients. Demographic data, comorbidities, trauma mechanism, Injury Severity Score (ISS), Glasgow Coma Score (GCS), lactate level, base excess, shock index (SI), clinical outcomes within 24 hours, and mortality of the flat IVC patients and non-flattened IVC patients were compared. RESULTS: 116 (30.6%) were found to have a flat IVC and 263 (69.4%) patients were found to have a non-flattened IVC. There was no significant difference between flat IVC patients and non-flattened IVC patients in terms of age, gender, comorbidity, and trauma mechanism (p>0.05). Flat IVC patients had a higher SI of 0.9 and above (p

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Inferior vena cava size is not associated with shock following injury

Abstract: Diagnostic test, level III.

Cited by 10 publications

References 7 publications

Inferior vena cava calibre on paediatric trauma CT may be a useful predictor for the development of shock

Inferior vena cava calibre on paediatric trauma CT may be a useful predictor for the development of shock

Inferior Vena Cava Volume Is an Independent Predictor of Massive Transfusion in Patients With Trauma

The Role of Flatness Index of Inferior Vena Cava in Early Hypovolemic Shock Concerning Blunt Torso Trauma Patients

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