Abdominal Radiology Determining the Predictive Value of Risk Factors in the Development of Retroperitoneal Hemorrhage

Determining the Predictive Value of Risk Factors in the Development of Retroperitoneal Hemorrhage Ahmed Fadl, MA, MD, Winthrop-University Hospital, Mineola, NY; Amanjit Baadh, MD; Nicholas A. Georgiou, MD; Man Hon, MD; Douglas S. Katz, MD; Jason C. Hoffmann, MD (jhoffmann@winthrop.org) PURPOSE: Retroperitoneal bleed (RPB) is an uncommon and potentially life-threatening condition often requiring a high index of suspicion to diagnose correctly. Concern for RPB is often raised, given physical examination findings and pertinent laboratory values. Noncontrast computed tomography (CT) is a fast and accurate means to emergently assess these patients. We retrospectively evaluated specific risk factors in a series of patients and determined their predictive values in developing a retroperitoneal hemorrhage when correlating with CT findings. METHOD AND MATERIALS: A single institutional retrospective analysis of 1000 consecutive patients who underwent a noncontrast CT of the abdomen and pelvis to evaluate specifically for retroperitoneal bleed was conducted. Patients were selected from a database of CT imaging requests during a 4-year period (June 2008–June 2011). Vital signs, recent invasive procedures, coagulation panel, hematologic status, and anticoagulant use were documented. Corresponding CT imaging at the time of evaluation was analyzed by two board-certified radiologists for the presence of a retroperitoneal bleed. Findings were subsequently compared between the RPB versus non-RPB cohort. RESULTS: Of the 1000 patients meeting inclusion criteria, 29 were found to have CT-confirmed retroperitoneal bleeds. A randomly selected equal-size cohort with CT-confirmed studies negative for RPB was gathered for comparison. Analysis demonstrated that the CTconfirmed RPB patients had a statistically significant low mean arterial pressure (MAP), with average MAP of 76 mm Hg versus 86 mm Hg in control group (P = .0008). Recent invasive procedure was also found to have significance, with 24 of 29 in the RPB group having recent invasive procedures, compared to three of 29 in the control group (P = .0068). Drop in hemoglobin/hematocrit, coagulation panel, and anticoagulant use were not found to have statistical significance. CONCLUSION: Although uncommon, RPB warrants a high index of suspicion and prompt evaluation due to associated morbidity and mortality. Our initial data suggest that low mean arterial pressure and a recent invasive procedure have predictive value in determining which patients should be emergently imaged.