PD02-01 IMPACT OF TRAUMA CENTER DESIGNATION ON RENAL TRAUMA OUTCOMES: EVIDENCE FOR UNIVERSAL MANAGEMENT

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I1 Apr 2018PD02-01 IMPACT OF TRAUMA CENTER DESIGNATION ON RENAL TRAUMA OUTCOMES: EVIDENCE FOR UNIVERSAL MANAGEMENT Marc Bjurlin, Audrey Renson, Richard Jacob Fantus, and Richard Joseph Fantus Marc BjurlinMarc Bjurlin More articles by this author , Audrey RensonAudrey Renson More articles by this author , Richard Jacob FantusRichard Jacob Fantus More articles by this author , and Richard Joseph FantusRichard Joseph Fantus More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.226AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Tiered delivery of trauma care has resulted in improved trauma outcomes at level I trauma centers compared to non-level I centers. In the era of conservative management of kidney injuries, comparison of outcomes of renal trauma by hospital designation is not well studied. Our study objective was to evaluate the initial management of renal trauma, assess patterns of management based on hospital trauma level designation, and analyze management trends over time. METHODS This retrospective cohort study included renal trauma from the National Trauma Data Bank 2010-2015. We examined the association between hospital trauma level designation (level I vs transferred to level I vs non-level I), and renal trauma management including nephrectomy, angioembolization, and nonoperative management, along with presence of any annual linear time trends in management. RESULTS We analyzed 51,798 renal trauma records; 44,838 low grade (AAST I-III) and 6,359 high grade (IV-V) injuries. After adjusting for comorbidities, demographics, and hospital characteristics, odds of nephrectomy, angioembolization, and nonoperative management were similar in patients transferred to a level I and directly admitted to level I centers, compared to those treated at non-level I for both high and low grade injuries (Table 1), although mortality was lower in those transferred to level I centers (OR 0.70, 95% Cl 0.61-0.80, p<0.001). Change over time of management of high grade renal injuries demonstrated a decrease in the use of nephrectomy (p=0.007) while rates of angioembolization remained constant (p=0.33) (Figure 1). CONCLUSIONS In this contemporary trauma analysis, outcomes of both low and high grade renal trauma are similar across those patients managed in tiered trauma centers, signifying dissemination of collective renal trauma management. The rate of nephrectomy has decreased for high grade renal injury over our study period suggesting new adoption of kidney sparing management. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e64-e65 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Marc Bjurlin More articles by this author Audrey Renson More articles by this author Richard Jacob Fantus More articles by this author Richard Joseph Fantus More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...