ISRA May 2022

The Use of Contrast Enhanced Chest and Abdominal CT in Patients with Non-Traumatic Undifferentiated Hemodynamic Shock

Matan Kraus 1 Matan Kraus 1,2 Noam Tau 1,2 Larisa Guranda 1,2
1Radiology, Sheba Tel Hashomer, Israel
2Sackler Faculty of Medicine, Tel Aviv University, Israel

Purpose: To assess the impact of computed tomography (CT) of the chest and abdomen in patients with undifferentiated shock in the emergency department (ED). Secondary aim was to assess common etiologies and prognostic factors according to shock subtype.

Methods: This was a single-center, retrospective study evaluating patients with undifferentiated shock who underwent a dedicated "shock protocol" CT in the ED. Patients` clinical records, laboratory, imaging data and all-cause 90-days mortality were collected. Patients were classified to main shock categories – distributive, cardiogenic, hypovolemic, obstructive, multifactorial, and unknown. Impact of CT on patients` diagnosis and management was assessed based on physicians` reports.

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%). Shock type was unknown for 16 patients (15.7%). Based on clinical data and CT reports, shock etiology was diagnosed for 89.2% (91/102) patients. Sepsis was the most common etiology with 50% of all patients, followed by non-traumatic hemorrhage (15/102, 14.7%). Overall, 90-day mortality was 58.8%. For shock subtypes with at least 4 patients, unknown shock had the highest mortality rate with 75%. Statistically significant predictors of mortality were high creatinine levels (mean 2.7 vs. 1.8mg/dL, p=.023) and high lactate levels (mean 74.7 vs. 47.1mmol/L, p=.0019). Shock protocol CT led to change in differential diagnosis for 49% of all patients and led to change in management in 42.2%.

Conclusion: Contrast-enhanced shock protocol CT can serve as a useful tool in patients presenting to the ED with undifferentiated shock, both for aiding differential diagnosis and treatment. Future prospective, randomized, controlled trials are required to assess whether CT can improve patient morbidity and mortality.