Does routine repeat imaging change management in high-grade renal trauma? Results from three level 1 trauma centers

David B. Bayne, Anas Tresh, Nima Baradaran, Gregory Murphy, E. Charles Osterberg, Shellee Ogawa, Jessica Wenzel, Lindsay Hampson, Jack McAninch, Benjamin Breyer

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)1455-1459
Number of pages5
JournalWorld Journal of Urology
Volume37
Issue number7
DOIs
StatePublished - Jul 1 2019

Keywords

  • Collecting system injury
  • High-grade renal trauma
  • Renal trauma grade
  • Repeat imaging
  • Vascular injury

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