Presentation Authors: Christopher Loftus*, Niels Johnsen, Seattle, WA
Introduction: AUA guidelines state that high-grade renal injuries with urinary extravasation (UE) may be managed conservatively and followed with routine repeat imaging. We sought to examine whether routine, proactive follow-up renal imaging impacts the need for urologic intervention or risk of urologic-specific complications.
Methods: Patients treated at our level 1 trauma center between 2005 and 2017 were identified by ICD-9/10 codes from our institutional trauma registry. Individual patient charts and imaging were reviewed to identify all patients with American Association for the Surgery of Trauma (AAST) Grade IV renal injuries. Only those with UE were included and patients with penetrating trauma or mortality during the index hospitalization were excluded. Analyses were completed using JMPÂ® software.
Results: Of the 342 identified Grade IV injuries, 131 patients met criteria with UE on CT imaging at presentation; characteristics include median age 23 years (IQR: 17-43), 72.5% male gender, 49.2% with injuries due to MVC. No patient had immediate nephrectomy for UE, although 16.8% underwent an immediate endoscopic procedure (stent or retrograde pyelogram within 24h of admission). Of all patients with UE, 36.6% underwent endoscopic intervention and one patient ultimately required a nephrectomy. _x000D_
As compared to those without reimaging, patients who had proactive reimaging were older but otherwise similar in terms of gender, mechanism of injury and ISS (Table 1). Reimaging was not associated with a difference in rate of urologic intervention (RR=0.95, 95% CI 0.75-1.2) or time to intervention. However, proactively imaged patients had a higher mean number of radiating abdominal scans (2.5 vs 1.6, p < 0.01). Follow-up renograms were conducted in 48% of patients at a median of 103 days from injury. Renal salvage (split renal function >20%) was accomplished in 89.5% and routine reimaging was not associated with improved long-term renal function, RR= 0.91 (0.7-1.1).
Conclusions: Routine repeat imaging does not appear to alter outcomes or change the risk of urologic intervention for patients with UE from high-grade renal trauma. Proactive imaging was, however, associated with increased radiation from additional imaging. These data suggest that repeat imaging in the absence of symptoms may be avoidable.