PD12-03 IMPACT OF A RENAL TRAUMA IMAGING PROTOCOL ON DELAYED IMAGING RATES AND HIGH-GRADE RENAL TRAUMA MANAGEMENT

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD12-03 IMPACT OF A RENAL TRAUMA IMAGING PROTOCOL ON DELAYED IMAGING RATES AND HIGH-GRADE RENAL TRAUMA MANAGEMENT Leah Chisholm, George Koch, Rohan Bhalla, Abimbola Ayangbesan, Jennifer Haung, William Walton, and Niels Johnsen Leah ChisholmLeah Chisholm More articles by this author , George KochGeorge Koch More articles by this author , Rohan BhallaRohan Bhalla More articles by this author , Abimbola AyangbesanAbimbola Ayangbesan More articles by this author , Jennifer HaungJennifer Haung More articles by this author , William WaltonWilliam Walton More articles by this author , and Niels JohnsenNiels Johnsen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003259.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Delayed-phase imaging (DPI) is recommended by the American Urological Association (AUA) for suspected renal injuries. Our institution historically obtained delays in less than 30% of American Association for the Surgery of Trauma (AAST) grade III-V renal injuries. In August 2021, we implemented a renal trauma imaging protocol to improve AUA guideline adherence (Figure 1). We sought to compare patient outcomes to further evaluate the utility of DPI in high-grade renal trauma. METHODS: Trauma patients with an AAST III-V renal injury presenting from January 2005 to September 2022 were identified from our institutional trauma registry. Patients with a contrasted computed tomography scan of the abdomen on admission were included. For patients without DPI, AAST IV grades were assigned based on the depth and location of renal lacerations and character of retroperitoneal fluid. DPI rates and patient outcomes were compared before and after implementation of our renal trauma imaging protocol. RESULTS: Of 742 patients, 650 (87.6%) were in the pre-protocol group and 92 (12.4%) in the post-protocol group. AAST III renal injuries were the most common among both groups, however AAST IV injuries were more frequent in the post-protocol cohort (30.4%) whereas AAST V injuries were more frequent in the pre-protocol group (11.5%). Following protocol implementation, the rate of DPI on admission for high grade renal trauma patients nearly tripled from 22.8% to 58.7% (p<0.001). The rate of follow-up cross-sectional imaging also increased from 11.7% to 58.7% (p<0.001). Despite increased guideline-adherent imaging, there was no significant difference in interventions for urinary extravasation (6.5% vs. 2.2%, p=0.10). However, there was a significant increase in angioembolizations for hemorrhage (3.5% vs 9.8%, p<0.01). Rates of all-cause readmission (9.1% vs. 5.4%, p=0.24) and renal-specific readmission (0.5% vs. 0.0%, p=0.51) were unchanged. CONCLUSIONS: The implementation of a multi-disciplinary renal trauma imaging protocol improves AUA guideline adherence. While guideline-concordant imaging led to more procedures for bleeding, rates of intervention for urinary extravasation, all-cause readmissions, or renal-specific readmissions were unchanged. Further research into the indications for DPI is needed. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e401 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leah Chisholm More articles by this author George Koch More articles by this author Rohan Bhalla More articles by this author Abimbola Ayangbesan More articles by this author Jennifer Haung More articles by this author William Walton More articles by this author Niels Johnsen More articles by this author Expand All Advertisement PDF downloadLoading ...