MP29-07 ADMISSION AND INTER-HOSPITAL TRANSFER PATTERN OF ISOLATED LOW GRADE RENAL TRAUMA AT A LEVEL 1 TRAUMA CENTER

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I (MP29)1 Apr 2020MP29-07 ADMISSION AND INTER-HOSPITAL TRANSFER PATTERN OF ISOLATED LOW GRADE RENAL TRAUMA AT A LEVEL 1 TRAUMA CENTER Vishnu Iyer*, Monica Valvilala, Hunter Wessells, Emma Gause, and Judith Hagedorn Vishnu Iyer*Vishnu Iyer* More articles by this author , Monica ValvilalaMonica Valvilala More articles by this author , Hunter WessellsHunter Wessells More articles by this author , Emma GauseEmma Gause More articles by this author , and Judith HagedornJudith Hagedorn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000868.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The management of low grade renal trauma (Grade I/II as defined by the American Association for the Surgery of Trauma) has been well described in the literature and national guidelines; however, there is a lack of admission and transfer protocols for low grade renal trauma. The aim of this study is to examine the admission and transfer pattern of isolated low grade renal trauma at a level 1 trauma center, which is the referral center for approximately 214 lower level regional trauma centers. METHODS: Our study employed a retrospective cohort design to analyze patients with low grade renal trauma (AAST grade I/II) at a level 1 trauma center from 2005 to 2018. We used an Abbreviated Injury Score (AIS) < 3 for non-abdominal categories and excluded all patients with any evidence of non-renal abdominal injury to ensure that ICU admission/hospital transfer was due to renal trauma alone (n=87). Patients were categorized into floor/Intensive Care Unit (ICU) admission groups and their treatment and outcomes were compared. RESULTS: We identified a total of 586 low grade renal traumas (41% of all renal traumas). Isolated renal trauma was found in 87 patients (52 grade I, 34 grade II). The mean age of the 31 floor admits was 32.93 and 41.26 for the 46 ICU admits. Mean Injury Severity Score (ISS) was 7.7 (Interquartile Range (IQR) =4) for the floor admits and 8 (IQR=3.75) for the ICU admits. Blood products were administered only to 3 (6.5%) ICU patients who were all over the age of 60. Nobody received vasopressors. There were 14 (45.1%) floor patients and 26 (56.5%) ICU patients that were transferred from a lower level trauma center. Of the transferred patients, 85% were discharged in < 72 hrs. Mean length of stay for ICU patients was 37 hours (IQR= 23 hrs). All patients were alive post-discharge and those < 65 years old without other renal conditions suffered zero post-discharge complications. Of the 5 patients that suffered post-discharge complications, 4 were > 65 years old and one was a 15 year old with a known history of ureteropelvic junction obstruction. CONCLUSIONS: We found a high number of isolated low grade renal injuries who were either admitted to the ICU or transferred to our level 1 trauma center. Given the rapid discharge, low transfusion rate, and low complication rate in these patients, ICU admission and inter-hospital transfer are unnecessary and indicate over-utilization of resources. Further studies are needed to confirm similar outcomes in patients managed with this approach. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e431-e431 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vishnu Iyer* More articles by this author Monica Valvilala More articles by this author Hunter Wessells More articles by this author Emma Gause More articles by this author Judith Hagedorn More articles by this author Expand All Advertisement PDF downloadLoading ...