Association of computed tomography-derived vascular indices with shock and blood transfusion in blunt abdominal trauma: a structural equation modeling approach.
4 affiliations
- 1Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
- 2Department of Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
- 3Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
- 4Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Abstract
Hypovolemic shock and blood transfusion requirement are critical early outcomes in blunt abdominal trauma. Conventional clinical parameters may underestimate physiological compromise, particularly in occult shock. Computed tomography (CT)-derived vascular indices, including inferior vena cava (IVC) morphology and IVC-to-aorta ratios, have been proposed as complementary imaging biomarkers of volume depletion, yet evidence on which specific metrics best predict these outcomes remains inconsistent. This study aimed to identify CT-derived vascular metrics associated with shock and blood transfusion requirements in adults with blunt abdominal trauma, and to evaluate their added value when integrated with clinical indicators within a holistic diagnostic framework. Consecutive adult patients with blunt abdominal trauma who underwent contrast-enhanced abdominopelvic CT within three hours of arrival were retrospectively included. Epidemiological and clinical data were collected. IVC (minimum, maximum diameters, and area) at four levels (hepatic, suprarenal, juxtarenal, infrarenal) and aorta diameters were measured. Logistic regression identified predictors of shock at presentation and blood transfusion within the first 24 hours, while structural equation modeling (SEM) elucidated structural relationships among clinical and CT-derived vascular variables associated with blood transfusion. A total of 190 patients (mean age 39.8±15.1 years; 151 men) were included, 49 (25.8%) with shock and 79 (41.6%) requiring blood transfusion. Median Abbreviated Injury Scale-Abdomen (AIS-Abdomen) was 3 (range, 0-5), and median Injury Severity Score (ISS) was 22 (range, 4-75). Small infrarenal IVC area <1.5 cm2 and aorta diameter <1.5 cm was linked to higher odds of shock (odds ratio: 2.979-4.717, P=0.002-0.010). A lower suprarenal IVC/aorta ratio was associated with a higher likelihood of transfusion (odds ratio: 0.211, P=0.026) along with higher heart rate, ISS, AIS-Abdomen, and prothrombin time (PT). The final SEM model explained 70.5% of the variance (R2=0.705) and identified four contributory pathways to blood transfusion, three of which reached statistical significance, with the coagulopathy pathway showing a non-significant trend (P=0.075). Infrarenal IVC area and aorta diameter were significantly associated with shock, whereas the suprarenal IVC/aorta ratio was associated with blood transfusion requirement. These CT-derived vascular indices provide independent predictive value for shock and blood transfusion when integrated with clinical parameters, supporting a comprehensive quadruple driver model for trauma resuscitation in which transfusion decisions arise from the interaction of four key domains: (I) anatomical injury burden, represented by ISS; (II) hemodynamic instability, represented by shock status and heart rate; (III) coagulopathy, represented by PT; and (IV) radiological hypovolemia, represented by the suprarenal IVC/aorta ratio. As a relative index that compensates for individual body habitus and physiological variability, the suprarenal IVC/aorta ratio is prioritized over absolute IVC dimensions within this framework, supporting safer and more robust clinical application in trauma resuscitation.
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BibTeX
@article{thawatchai2026association,
title = {{Association of computed tomography-derived vascular indices with shock and blood transfusion in blunt abdominal trauma: a structural equation modeling approach.}},
author = {Natthaphat Thawatchai and Jitti Chatpuwaphat and Sitthiphan Limphanudom and Sasima Tongsai and Sirikan Pongsirikul and Natthida Owattanapanich and Rathachai Kaewlai},
journal = {Quantitative imaging in medicine and surgery},
year = {2026},
month = sep,
doi = {10.21037/qims-2026-1101},
url = {https://europepmc.org/article/MED/42997933},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Association of computed tomography-derived vascular indices with shock and blood transfusion in blunt abdominal trauma: a structural equation modeling approach.
AU - Natthaphat Thawatchai
AU - Jitti Chatpuwaphat
AU - Sitthiphan Limphanudom
AU - Sasima Tongsai
AU - Sirikan Pongsirikul
AU - Natthida Owattanapanich
AU - Rathachai Kaewlai
PY - 2026
DA - 2026/09/30
JO - Quantitative imaging in medicine and surgery
DO - 10.21037/qims-2026-1101
UR - https://europepmc.org/article/MED/42997933
AB - Hypovolemic shock and blood transfusion requirement are critical early outcomes in blunt abdominal trauma. Conventional clinical parameters may underestimate physiological compromise, particularly in occult shock. Computed tomography (CT)-derived vascular indices, including inferior vena cava (IVC) morphology and IVC-to-aorta ratios, have been proposed as complementary imaging biomarkers of volume depletion, yet evidence on which specific metrics best predict these outcomes remains inconsistent. This study aimed to identify CT-derived vascular metrics associated with shock and blood transfusion requirements in adults with blunt abdominal trauma, and to evaluate their added value when integrated with clinical indicators within a holistic diagnostic framework. Consecutive adult patients with blunt abdominal trauma who underwent contrast-enhanced abdominopelvic CT within three hours of arrival were retrospectively included. Epidemiological and clinical data were collected. IVC (minimum, maximum diameters, and area) at four levels (hepatic, suprarenal, juxtarenal, infrarenal) and aorta diameters were measured. Logistic regression identified predictors of shock at presentation and blood transfusion within the first 24 hours, while structural equation modeling (SEM) elucidated structural relationships among clinical and CT-derived vascular variables associated with blood transfusion. A total of 190 patients (mean age 39.8±15.1 years; 151 men) were included, 49 (25.8%) with shock and 79 (41.6%) requiring blood transfusion. Median Abbreviated Injury Scale-Abdomen (AIS-Abdomen) was 3 (range, 0-5), and median Injury Severity Score (ISS) was 22 (range, 4-75). Small infrarenal IVC area <1.5 cm2 and aorta diameter <1.5 cm was linked to higher odds of shock (odds ratio: 2.979-4.717, P=0.002-0.010). A lower suprarenal IVC/aorta ratio was associated with a higher likelihood of transfusion (odds ratio: 0.211, P=0.026) along with higher heart rate, ISS, AIS-Abdomen, and prothrombin time (PT). The final SEM model explained 70.5% of the variance (R2=0.705) and identified four contributory pathways to blood transfusion, three of which reached statistical significance, with the coagulopathy pathway showing a non-significant trend (P=0.075). Infrarenal IVC area and aorta diameter were significantly associated with shock, whereas the suprarenal IVC/aorta ratio was associated with blood transfusion requirement. These CT-derived vascular indices provide independent predictive value for shock and blood transfusion when integrated with clinical parameters, supporting a comprehensive quadruple driver model for trauma resuscitation in which transfusion decisions arise from the interaction of four key domains: (I) anatomical injury burden, represented by ISS; (II) hemodynamic instability, represented by shock status and heart rate; (III) coagulopathy, represented by PT; and (IV) radiological hypovolemia, represented by the suprarenal IVC/aorta ratio. As a relative index that compensates for individual body habitus and physiological variability, the suprarenal IVC/aorta ratio is prioritized over absolute IVC dimensions within this framework, supporting safer and more robust clinical application in trauma resuscitation.
SN - 2223-4292
SN - 2223-4306
ER -