Abstract
Purpose
Guidelines call for routine reimaging of Grade 4–5 renal injuries at 48–72 h. The aim of the current study is to evaluate the clinical utility of computed tomography (CT) reimaging in high-grade renal injuries.
Materials and methods
We assembled data on 216 trauma patients with high-grade renal trauma at three level 1 trauma centers over a 19-year span between 1999 and 2017 in retrospectively collected trauma database. Demographic, radiographic, and clinical characteristics of patients were retrospectively reviewed.
Results
In total, 151 cases were Grade 4 renal injuries, and 65 were Grade 5 renal injuries. 53.6% (81) Grade 4 and 15.4% (10) Grade 5 renal injuries were initially managed conservatively. Of the 6 asymptomatic cases where repeat imaging resulted in intervention, 100% had collecting system injuries at initial imaging. Collecting system injuries were only present in 42.9% of cases where routine repeat imaging did not trigger surgical intervention. Collecting system injury at the time of initial imaging was a statistically significant predictor of routine repeat imaging triggering surgical intervention (p = 0.022). Trauma grade and the presence of vascular injury were not significant predictors of intervention after repeat imaging in asymptomatic patients.
Conclusion
In asymptomatic patients with high-grade renal trauma, the number needed to image is approximately one in eight (12.5%) to identify need for surgical intervention. There is potentially room to improve criteria for routine renal imaging in high-grade renal trauma based on the more predictive imaging finding of collecting system injury.
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DBB, MD, MPH: Protocol/project development, Data collection or management, Data analysis, Manuscript writing/editing. AT: Data collection or management, Manuscript writing/editing. NB, MD: Data collection or management, Data analysis, Manuscript writing/editing. GM, MD: Protocol/project development, Data collection or management, Data analysis, Manuscript writing/editing. ECO, MD: Protocol/project development, Data collection or management, Data analysis, Manuscript writing/editing. SO, MD: Data collection or management. JW: Data collection or management. LH, MD: Data analysis, Manuscript writing/editing. JM, MD: Protocol/project development, Data collection or management, Data analysis. BB, MD: Protocol/project development, Data collection or management, Data analysis, Manuscript writing/editing.
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Research involving human participants and/or animals
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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This is a retrospective review. For this type of study formal consent is not required.
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Bayne, D.B., Tresh, A., Baradaran, N. et al. Does routine repeat imaging change management in high-grade renal trauma? Results from three level 1 trauma centers. World J Urol 37, 1455–1459 (2019). https://doi.org/10.1007/s00345-018-2513-2
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DOI: https://doi.org/10.1007/s00345-018-2513-2