Moderated Poster

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MP76-18: Variability in Intensive Care Unit Use In Patients With Renal Trauma

Monday, May 15
9:30 AM - 11:30 AM
Location: BCEC: Room 156

Presentation Authors: Judith C. Hagedorn*, D. Alex Quistberg, Saman Arbabi, Monica S. Vavilala, Hunter Wessells, Seattle, WA

Introduction: Patients with renal trauma are frequently admitted to the intensive care unit (ICU) adding significant cost to the health care system despite lack of evidence suggesting benefit. We aimed to examine the variability of ICU use in patients with isolated renal trauma and assess the factors that may influence admission to a higher level of care.

Methods: The National Trauma Data Bank was used to identify isolated (Abbreviated Injury Severity Score ≤ 2 non-kidney regions) renal trauma patients of any age who were admitted to a designated trauma hospital from 2007 - 2014. The primary outcome was initial emergency department (ED) disposition to the ICU. Pre-admission variables assessed were age, gender, ethnicity, hypotension in ED, mechanism of injury, renal injury grade, comorbidities, insurance status, hospital trauma level, and region. Multivariable normal multiple imputation was used to address missing renal injury grade data (29% missing). Adjusted risk ratios (RR) and 95% confidence intervals (95% CI) were estimated from imputations using Poisson regression with robust standard errors and clustering by facility.

Results: There were 20,755 eligible subjects with a mean age of 34.3 years. Of patients with any ICU stay during hospitalization 50% had low grade renal injuries (AAST grade I/II). Over one-third of high grade injuries (AAST grade IV/V) were managed exclusively on the ward. In multivariable analysis, elderly patients were 33% more likely to be admitted to the ICU (95% CI 1.16, 1.52), as were those injured via firearm (aRR 3.71, 95% CI 3.71, 1.35), were hypotensive in the ED (aRR 2.77, 95% CI 2.13, 3.61), and those with more comorbidities (aRR 1.14; 95% CI 1.09, 1.19). The higher grade renal injuries were more likely to be admitted to the ICU (grade III aRR 1.65, 95% CI 1.49, 1.81; grade IV aRR 2.90, 95% CI 2.46, 3.42; grade V aRR 3.56, 95% CI 2.96, 4.28). Hospital trauma level and region were also significantly associated with ICU admission (Level II trauma facilities: aRR 1.24, 95% CI 1.03, 1.49; Southern region: aRR 1.36, 95% CI 1.02, 1.82).

Conclusions: We found that older age, more comorbidities, firearm injury, hypotension in the ED, higher grade injury, hospital trauma level II and Southern region were significantly associated with ICU admission in isolated renal trauma. A large proportion of patients admitted to the ICU have low grade renal injuries, whereas a notable portion of high grade injuries are being managed on the floor. The variability in admission patterns suggests a need for disease-specific guidelines for ICU admission in order to provide safe, cost effective, and efficient health care.

Source Of Funding: None

Judith C. Hagedorn, MD, MHS

University of Washington

Dr. Hagedorn is originally from Germany and moved to the United States to attend Rice University in Houston, Texas, where she competed on the Division-1 varsity tennis team. After graduating cum laude with a bachelor of arts in psychology, she completed her master’s degree in health science at the Johns Hopkins Bloomberg School of Public Health. She then moved from Maryland to California to study medicine at Stanford University. She remained at Stanford for her urology residency training.
Following residency, Dr. Hagedorn completed a fellowship in genitourinary reconstructive surgery and trauma at the University of Washington, Seattle under the mentorship of Dr. Hunter Wessells. During the one year fellowship, Dr. Hagedorn served as clinical instructor at Harborview Medical Center. She was accepted into a T-32 NIH sponsored research fellowship and conducted renal trauma research at the local Harborview Injury Prevention Center.
She was recently hired as assistant professor in the department of urology at the University of Washington, Seattle. She is a surgeon, educator and researcher who specializes in urethral stricture disease, male incontinence, erectile dysfunction, and urogenital trauma.

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