Routine Repeat Research Articles

PRS78 Burden of Idiopathic Pulmonary Fibrosis (IPF) on Quality of Life (QOL), Work Productivity and Healthcare Use

Despite recent advances, current IPF therapies fail to halt progression and have limited impact on QoL. Hospitalization due to IPF is common. We studied real-world burden of IPF on QoL (EQ-5D), hospitalization, work impairment and healthcare visits. A large cross-sectional survey was conducted in France, Germany, Japan and the USA; 244 physicians reported data on 1,249 patients with IPF, 739 of whom provided self-reported data. EQ-5D health utility values in IPF were worse than moderate-to-severe chronic obstructive pulmonary disease and similar to non-small cell lung cancer, based on comparative real-world data. Those on treatment (84.7%) consulted a healthcare professional more than those untreated (8.5 vs 5.2 visits/year); 33% and 10% made ≥10 visits/year, respectively, largely for routine check-ups and repeat prescriptions. Hospitalization was more common when disease was perceived as severe by physicians, but 5–17% of patients with mild functional impairment were still hospitalized in the last year. Work productivity was impaired by 28%, 45%, 40% and 34% in France, Germany, Japan and USA, respectively. Data show the marked burden of IPF on QoL, work productivity and healthcare resource use, highlighting the need for optimization of current management. ACKNOWLEDGMENTS : This study was funded by Galapagos NV (Mechelen, Belgium). Writing support from Hannah Mace MPharmacol, CMPP (Aspire Scientific Ltd, Bollington, UK) was funded by Galapagos NV.

Antiplatelet therapy is associated with a high rate of intracranial hemorrhage in patients with head injuries

BackgroundAntiplatelet agents are increasingly used in cardiovascular treatment. Limited research has been performed into risks of acute and delayed traumatic intracranial hemorrhage (ICH) in these patients who sustain head injuries....

Does routine repeat imaging for blunt high-grade renal trauma lead to unnecessary interventions?

Most high-grade renal injuries with urinary extravasation (UE) may be managed conservatively without intervention. For such patients, the American Urological Association Urotrauma guidelines recommend repeat imaging within 48 to 72 hours of injury. We sought to examine whether routine, proactive follow-up renal imaging was associated with need for urologic intervention or risk of complications. Patients treated to an urban level 1 trauma center for a five-state region, between 2005 and 2017 were identified by International Classification of Diseases, Ninth Revision and Tenth Revision, codes from a prospectively collected institutional trauma registry. Individual patient charts and imaging were reviewed to identify all patients with American Association for the Surgery of Trauma grade IV renal injuries. Those with UE were included, and patients with penetrating trauma, immediate urologic surgery, or in-hospital mortality were excluded. Of 342 patients with grade IV injuries, 108 (32%) met the inclusion criteria. Urologic intervention was performed in 23% (25 of 108 patients) including endoscopic procedure (24 of 108 patients) and nephrectomy (1 of 108 patients). Repeat imaging was performed within 48 to 72 hours after initial imaging in 65% (70 to 108 patients). Patients who underwent routine reimaging had a higher rate of undergoing subsequent urologic procedure (31.4% vs. 7.1%, p = 0.008). For patients with reimaging who underwent a procedure, 18% (4 of 22 patients) were symptomatic, while all nonroutinely reimaged patients who underwent a procedure were symptomatic (3 of 3 patients). Patients who received routine repeat imaging had a higher mean number of abdominal computed tomography scans during their admission (2.5 vs. 1.7, p < 0.001), while the complication rate was similar between groups. Patients with grade IV renal lacerations with UE from blunt trauma who received routine repeat imaging were more likely to undergo an operation in the absence of symptoms and received more radiation during their hospital stay. Forgoing repeat imaging was not associated with an increase in urological complications. These data suggest that, in the absence of signs/symptoms, repeat imaging may be avoidable. Therapeutic/care management, level IV.

HEMORRHAGIC PROGRESSION OF CONTUSION IN PATIENTS WITH MILD TRAUMATIC BRAIN INJURY ON THE ROUTINE REPEAT HEAD COMPUTED TOMOGRAPHY

Computed tomography (CT) scan is a standard for the diagnosis of intracranial pathology after traumatic brain injury (TBI). Hemorrhagic progression of contusion (HPC) is frequently seen on repeat CT, but its clinical and radiological significance in case of mild TBI is not well define. The aim of the study: to evaluate the result of routine repeat head CT in patients with mild TBI and brain contusions. Materials and methods: retrospective analysis of management of patients with mild TBI (Glasgow Coma Scale (GCS) score – 13 to 15) and cerebral contusion. All patients were treated at the Kyiv City Clinical Emergency Hospital between 2016 and 2017. Results: within 202 patients with mild TBI, 87 (43.1 %) met the inclusion criteria and were selected for detailed analysis. There were 69 (79.3 %) men and 18 (20.7 %) women. The mean age of the patients was 43.8±12.7 years (17–82 years). The average time between trauma and CT was 3.3 hours. The average volume of contusion on the initial CT was 1.9±0.6 cm3 (0.2–9.6 cm3). The average time of routine CT was 6.8 hours (range 4–24 hours) after the initial scans. HPC was found in 24 (30.7 %) of 87 cases. The average volume of brain contusion on the repeat CT was 2.3±0.5 cm3 (0.2-17.1 cm3). In 3 (3.4 %) patients the size of the hematoma increased. Clinical deterioration occurred in 10 (11.5 %) patients. Six (6.9 %) patients were operated after a CT scan due to HPC with midline shift in 4 cases and increasing of subdural hematoma – 2 cases. Four of these patients had clinical deterioration, and 2 patients were neurological stable. Patients with HPC at admission had lower points of GCS, fractures of the skull (both p &lt;0.001), subdural blood collection (p=0.002), a higher average duration of treatment 8.1±4.2 vs 14.3±5.2 days (p=0.0001), and mortality rate 0 vs. 3 (12.5 %) (p=0.02). Conclusions: Routine repeat CT in patients with mild TBI with brain contusions is aimed to find a patients with s high risk for clinical deterioration. One third of patients with mild TBI and brain contusion experienced HPC. Patients with HPC often have unfavorable clinical course with higher average duration of treatment, delay surgical treatment and mortality rate.

Necessity of Routine Repeat Testing of Critical Values in Various Working Shifts.

Background & Objective:Accurate and timely reporting of critical values is an important issue. There is some doubt whether repeat testing of critical values would offer any advantage over single testing or not. The aim of this study was evaluation of utility of routine repeat testing of critical values in our referral center and to compare probable variations in different working shifts.Methods:Clinical results of serum Potassium, Calcium, Blood Hemoglobin and Prothrombin Time (INR: International Normalized Ratio) were evaluated for three months.Results:Totally, 178, 96, 67 and 107 consecutive critical values for Potassium, Calcium, Hemoglobin and INR were reported, respectively. In potassium and Hemoglobin 5.05% and 1.17% of retest runs exceeded the accep1 tolerance limit. All of the calcium retest results were within the acceptable limit. For INR, 21/107 retest results did not meet the acceptable tolerance limit, nine still were critical. Afternoon working run performance was significantly better than the two others.Conclusion:Our observation suggests that routine repeat of hematology and chemistry critical test result is not necessary and may adversely affect patient safety measure. However, attention should be paid to results greater than analytical measurement range and all such results should be repeated before reporting.

Routine Repeat Head CT Does Not Change Management in Trauma Patients on Novel Anticoagulants

IntroductionGuidelines for imaging anticoagulated patients following a traumatic injury are unclear. Interval CT head (CTH) is often routinely performed after initial negative CTH to assess for delayed intracranial hemorrhage (ICH-d). The rate of ICH-d for patients taking novel oral anticoagulants (NOACs) is unknown. We hypothesized that the incidence of ICH-d in patients on NOACs would be similar, if not lower to that of warfarin, and routine repeat CTH after initial negative would not change management, and thus, may not be indicated. Materials and MethodsAnticoagulated patients presenting with blunt trauma to a level I trauma center between 2016 and 2018 were evaluated. Exclusion criteria included: positive initial CTH and those taking nonoral anticoagulation or antiplatelet agents alone (without warfarin or NOAC). Outcomes included: ICH-d, discharge GCS, administration of reversal agents, neurosurgical intervention, readmission, and death. Multivariable regression was performed to evaluate patient factors associated with the development of ICH-d. ResultsA total of 332 patients met the inclusion criteria. Patients were divided into a warfarin group (n = 191) and NOAC group (n = 141). The incidence of ICH-d in the warfarin group was 2.6% (5/191) and 2.1% (3/141) in the NOAC group (P = 0.77). There were no reversal agents administered, neurosurgical interventions, readmissions, or deaths in the NOAC group. ConclusionsLittle is known about the impact of NOACs in the setting of trauma, especially regarding risks of ICH-d following traumatic injury. In the NOAC group, ICH-d occurred only 2.1% of the time. In addition, there were no reversal agents given, neurosurgical interventions, or deaths. These data, taken together, suggest the limited utility of repeat imaging in this patient population.

Second-look TURBT: evaluation of anatomopatological and oncologic results in a single center.

Introduction:T1 bladder cancer is associated with a high risk of recurrence and progression; concomitant carcinoma in situ and/or multifocality are negative prognostic factors. Persistent disease after resection of T1 tumours has been observed in 33-55% of patients, and after resection of High-grade (HG) Ta tumour in 41,4%. It has been demonstrated that a second TURB can increase recurrence-free survival and it can make a restaging of the cancer.Patients and methods:From January 2011 to December 2016, 87 patients with superficial bladder tumor (Ta-T1), undergoing TURB and routine repeat TURB (Re-TURB) 4-6 weeks after the initial resection, were included in the study. Re-TURB was applied to the scar of the first resection and other suspicious lesions in the bladder. After the second-look, we studied the follow-up of each patient.Results:Specimens obtained during the second TURBT showed no tumor in 47 (54,02%) patients; 40 (45,98%) patients had residual cancer: 34 of them had cancer of the same stage, 6 patients of pT1 had a lower stage, and 3 had a higher stage. 5 patient underwent radical cistectomy immediatly after re-TURBT. During the first year of follow up, 15 patients had a recurrent bladder cancer; 2 of them underwent radical cistectomy.Conclusions:T1 bladder cancer is an high risk tumor, so that second-look TURBT is a valuable procedure for accurate staging of nonmuscle-invasive bladder cancer and it can guarantee a better eradication of the neoplasm. (www.actabiomedica.it)

The seroconversion rate of QuantiFERON-TB Gold In-Tube test in psoriatic patients receiving secukinumab and ixekizumab, the anti-interleukin-17A monoclonal antibodies.

BackgroundFor psoriatic patients receiving biologics, the concern of tuberculosis (TB) infection exists. Although the TB risk of anti-interleukin (IL)-17A agents is generally considered very low, more real-world data are needed to support the safety.ObjectivesThis study aims to provide the real-world experience of using serial QuantiFERON-TB Gold In-Tube (QFT-GIT) test among patients treated with secukinumab or ixekizumab in Taiwan, an intermediate TB burden country, for the detection of latent TB infection (LTBI) reactivation or newly acquired TB infection.MethodsThis retrospective review evaluated 100 consecutive patients with psoriasis receiving anti-IL-17A therapies who were checked with at least twice QFT-GIT between 2016 and 2019 in National Taiwan University Hospital, Taipei and Hsin-Chu, Taiwan.ResultsAmong the 100 patients, the baseline QFT-GIT results were negative in 81.0% (81/100), positive in 18.0% (18/100), and indeterminate in 1.0% (1/100) of patients. The overall outcomes in patients receiving at least 6 months of cumulative exposure to anti-IL-17A agents were persistently seronegative in 80 patients (80.0%), persistently seropositive in 14 patients (14.0%), seroconversion in 1 patient (1.0%), seroreversion in 3 patients (3.0%), and others in 2 patients (2.0%). In patients with at least 11 months of cumulative exposure, the seroconversion rate was 1.3% (1/79). The only case with seroconversion had a positive QFT-GIT result previously. No case of TB reactivation or newly acquired TB infection was identified during the follow-up.ConclusionsIn patients treated with anti-IL-17A monoclonal antibodies for psoriasis, routine serial repeat QFT-GIT testing was associated with lower seroconversion rate compared to real-world data of tumor necrosis factor-α inhibitors and anti-IL-12/23 antibody in Taiwan and in pivotal studies. Because clinical TB symptoms and signs are often preceded by QFT-GIF seroconversion, this result further supports the safety of anti-IL-17A agents in patients with psoriasis for LTBI.

Management and follow-up of renal injury-a10-year experience at aSwiss level1 traumacenter

The objective was to analyze patterns of injury, management, imaging, and follow-up care of renal trauma at aSwiss level1 trauma center. We examined 138 patients (>16years) with renal organ injuries who presented to our institution between January 2008 and March 2018. Data on demographics, patterns of injury, clinical presentation, management, and follow-up were recorded. The injury grade of the 142 injured kidneys was grade1 in 25% (n = 36), grade2 in 16% (n = 23), grade3 in 32% (n = 46), grade4 in 24% (n = 34), and grade5 in 2% (n = 3). The predominant injury mechanism was winter sports (45%). Conservative management was successful in all grade1 renal injuries, and 91%, 86%, 35%, and 33% of grade2, 3, 4, and5 injuries, respectively. Early follow-up with CT or MRI scan was performed in 23% of grade1-3 injuries and 57% of grade4-5 injuries with clinical signs of complications as the most frequent indication for grade1-3 injuries and routine follow-up imaging for grade4-5 injuries, respectively. In follow-up care (1-9months after injury) imaging showed persistent pathologies in 39% of grade1-3 renal injuries and 62% of grade4-5 injuries. Most minor renal injuries (grade1-3) can be successfully managed conservatively. Early follow-up imaging is indicated for patients showing clinical signs of complications. Routine repeat imaging may not be justified for high-grade renal injuries without clinical symptoms. Re-imaging in follow-up care still lacks evidence-based recommendations.

Persistent eosinophilia among 21 historic cases of Strongyloides stercoralis infection: a case for routine follow-up and repeat treatment.

Strongyloidasis affects more than 100 million people worldwide and causes persisting infection. We retrospectively reviewed 21 cases of parasitologically confirmed Strongyloides stercoralis infection at our centre. We found four individuals who had eosinophilia (>0.5x109/litre) more than 6mo after treatment. This may represent ongoing or relapsed infection. Our data support the need for continued follow-up of treated individuals, particularly those with abnormal host defences who are at risk of severe forms of the disease.

Role of repeat CT in mild to moderate head injury: an institutional study.

Patients with traumatic brain injury (TBI) often undergo repeat head CT scans to identify the possible progression of injury. The objective of this study is to evaluate the need for routine repeat head CT scans in patients with mild to moderate head injury and an initial positive abnormal CT scan. This is a retrospective study of patients presenting to the emergency department from January 2016 to December 2017 with Glasgow Coma Scale (GCS) scores > 8 and an initial abnormal CT scan, who underwent repeat CT during their in-hospital medical management. Patients who underwent surgery after the first CT scan, had a GCS score < 9, or had a normal initial CT scan were excluded. Demographic, medical history, and physical examination details were collected, and CT scans were reviewed. Radiological deterioration, neurological deterioration, and/or the need for neurosurgical intervention were the primary outcome variables. A total of 1033 patients were included in this study. These patients underwent at least two CT scans on an inpatient basis. Of these 1033 patients, 54.1% had mild head injury and 45.9% had moderate head injury based on GCS score at admission. The most common diagnosis was contusion (43.8%), followed by extradural hematoma (28.8%) and subdural hematoma (26.6%). A total of 2636 CT scans were performed for 1033 patients, with a mean of 2.55 per patient. Of these, 25 (2.4%) had neurological deterioration, 90 (8.7%) had a progression of an existing lesion or appearance of a new lesion on repeat CT, and 101 (9.8%) required neurosurgical intervention. Seventy-five patients underwent surgery due to worsening of repeat CT without neurological deterioration, so the average number of repeat CT scans required to identify one such patient was 21.3. On multiple logistic regression, GCS score at admission (p = 0.024), abnormal international normalized ratio (INR; p < 0.001), midline shift (p = 0.005), effaced basal cisterns (p < 0.001), and multiple hemorrhagic lesions (p = 0.010) were associated with worsening of repeat CT, neurological deterioration, and/or need for neurosurgical intervention. The role of routine repeat head CT in medically managed patients with head injury is controversial. The authors have tried to study the various factors that are associated with neurological deterioration, radiological deterioration, and/or need for neurosurgical intervention. In this study the authors found lower GCS score at admission, abnormal INR, presence of midline shift, effaced basal cisterns, and multiple lesions on initial CT to be significantly associated with the above outcomes.

Delayed Intracranial Hemorrhage in Patients with Head Trauma and Antithrombotic Therapy.

Background: Delayed intracranial hemorrhage can occur up to several weeks after head trauma and was reported more frequently in patients with antithrombotic therapy. Due to the risk of delayed intracranial hemorrhage, some hospitals follow extensive observation and cranial computed tomography (CT) protocols for patients with head trauma, while others discharge asymptomatic patients after negative CT. Methods: We retrospectively analyzed data on patients with head trauma and antithrombotic therapy without pathologies on their initial CT. During the observation period, we followed a protocol of routine repeat CT before discharge for patients using vitamin K antagonists, clopidogrel or direct oral anticoagulants. Results: 793 patients fulfilled the inclusion criteria. Acetylsalicylic acid (ASA) was the most common antithrombotic therapy (46.4%), followed by vitamin K antagonists (VKA) (32.2%) and Clopidogrel (10.8%). We observed 11 delayed hemorrhages (1.2%) in total. The group of 390 patients receiving routine repeat CT showed nine delayed hemorrhages (2.3%). VKA were used in 6 of these 11 patients. One patient needed an urgent decompressive craniectomy while the other patients were discharged after an extended observation period. The patient requiring surgical intervention due to delayed hemorrhage showed neurological deterioration during the observation period. Conclusions: Routine repeat CT scans without neurological deterioration are not necessary if patients are observed in a clinical setting. Patients using ASA as single antithrombotic therapy do not require in-hospital observation after a negative CT scan.

Cost-Effectiveness Analysis of Routine Repeat CT Head Scan in Patients on Novel Anticoagulation after Trauma

Cohan, Caitlin MD; Beattie, Genna MD; George, Elizabeth L. MD; Rothenberg, Kara MD; Dominguez, Dana A. MD; Victorino, Gregory P. MD, FACS Author Information

A longitudinal study on latent TB infection screening and its association with TB incidence in HIV patients

Latent TB infection (LTBI) in HIV patients, its treatment, and immunological recovery following highly active antiretroviral therapy (HAART) could interact and impact TB disease progression. We aim to examine the factors associated with LTBI and TB disease development among HIV patients. Longitudinal clinical and laboratory data were accessed from the largest HIV specialist clinic in Hong Kong, where HAART and yearly LTBI screening are routinely provided for HIV patients. Between 2002 and mid-2017, among 2079 HIV patients with 14119 person-years (PY) of follow-up, 32% of LTBI screened patients (n = 1740) were tested positive. The overall TB incidence was 1.26/100 PY from HIV diagnosis to HAART initiation, falling to 0.37/100 PY. A lower risk of TB disease progression was associated with local residence, Chinese ethnicity, negative baseline LTBI result, being on HAART, LTBI treatment, higher baseline CD4 and CD4/CD8 ratio. A positive test at baseline, but not subsequent testing results, was significantly associated with TB disease development. Baseline LTBI screening is an important strategy for identifying HIV patients at risk of TB disease progression. Routine repeat LTBI screening on an annual basis might not give additional benefits to patients on HAART with good immunological responses. Such practice should require re-evaluation.

Clinical significance of posttraumatic intracranial hemorrhage in clinically mild brain injury: a retrospective cohort study.

Much attention has been focused on management of severe traumatic brain injury (TBI); however, comparatively little is known about management of traumatic hemorrhage in clinically mild TBI. We aimed to clarify the role of clinical observation and repeat radiography for patients with mild TBI and abnormal findings on initial computed tomography (CT) of the head. We queried the neurotrauma database of the Ontario Trauma Registry and the Sunnybrook institutional database to identify patients with CT findings of a traumatic hemorrhage or calvarial fracture between November 2014 and December 2016. Exclusionary criteria were age less than 16 years, Glasgow Coma Scale (GCS) score less than 13, anticoagulant use, bleeding diathesis and midline shift greater than 5 mm. The primary outcome was the need for neurosurgical intervention. A total of 607 patients were included. Most (374 [61.6%]) had a GCS score of 15; 185 (30.5%) and 48 (7.9%) had a GCS score of 14 and 13, respectively. Five patients (0.8%) required surgical intervention, all within the first 72 hours, owing to clinical deterioration with subsequently demonstrated radiographic evidence of expanding hemorrhage. Most patients (506 [83.4%]) had routine repeat imaging, without documented change in their neurologic status. The majority of patients in our cohort had repeat imaging, which did not influence surgical management, at substantial cost to the health care system. The findings suggest the need to reevaluate repeat imaging protocols for this subset of patients with TBI.

MP04-04 PROACTIVE REPEAT IMAGING FOR BLUNT HIGH-GRADE RENAL TRAUMA WITH URINARY EXTRAVASATION DOES NOT IMPROVE OUTCOMES

INTRODUCTION AND OBJECTIVES:AUA guidelines state that high-grade renal injuries with urinary extravasation (UE) may be managed conservatively and followed with routine repeat imaging. We sought to ...

Nosocomial Mycobacterium tuberculosis transmission by brief casual contact identified using comparative genomics

This paper reports a case of nosocomial transmission of Mycobacterium tuberculosis by brief casual contact. Routine variable number tandem repeat typing in Yamagata Prefecture, Japan found that M.tuberculosis clinical isolates from two patients showed indistinguishable genotypes. The patients had an epidemiological relationship of sharing a waiting room in a hospital on the same day. As comparative genomics detected only two single nucleotide variants between the isolates, it was concluded that recent tuberculosis transmission occurred in the waiting room. These results indicate that the physical separation of infectious tuberculosis patients is an essential control measure for preventing unpredictable nosocomial transmission by casual contact.

Blood eosinophil levels in newborns with severe indirect hyperbilirubinemia treated with phototherapy

Objective The aim of this study was to investigate the effect of phototherapy on peripheral eosinophil counts in newborns with severe indirect hyperbilirubinemia needing phototherapy. Methods We conducted a search of Medline databases (PubMed, Medscape, ScienceDirect) and all materials available on the Internet. The initial search presented one articles that met the inclusion criteria. The articles studied the relation between peripheral eosinophil count and exposure to phototherapy. If the studies did not fulfill the inclusion criteria, they were excluded. Studies were assessed for whether ethical approval had been obtained, eligibility criteria has been specified, appropriate controls had been considered, adequate information had been provided, and assessment measures had been defined. Comparisons were made by means of structured review with the results tabulated. Results The study was conducted on 30 neonates suffering from severe indirect hyperbilirubinemia who served as the patient group and another 30 neonates who were normal and served as the control group. It was found that there was an increase in peripheral eosinophil count in neonates who were treated with phototherapy for 48–72 h. Conclusion Peripheral eosinophil count may be affected by phototherapy. The exact mechanism of neonatal jaundice/phototherapy and later risk of developing asthma is not clear yet, and further prospective studies in larger groups are needed. Neonatologists should concentrate on underlying problems, as eosinophilia is sometimes clinically insignificant with regard to morbidity and requires no specific treatment. In fact, it may be indirect evidence of clinical recovery. Unless eosinophilia is associated with clinical symptomatology, medical evaluation should be limited to routine follow-up examinations and repeat monitoring of absolute eosinophil counts.

Using Lean Six Sigma to Improve Delayed Intracranial Hemorrhage Screening in a Geriatric Trauma Population.

Geriatric trauma patients taking preinjury anticoagulant or antiplatelet (ACAP) medications are at greater risk for delayed intracranial hemorrhage (DICH), a rare but potentially life-threatening condition. Routine repeat head computed tomography (RRHCT) scans can identify DICH. Our objective was to decrease the rate of missed RRHCT in a level 1 Midwest trauma center geriatric minor trauma population on preinjury ACAP medications. The objective of the quality improvement project was to identify the root cause of the missed RRHCTs and to implement a comprehensive solution to reduce rates of missed RRHCTs. Medical records from before and after the intervention were evaluated. Frequencies and percentages were calculated. In addition, χ and logistic regression were utilized. The Lean Six Sigma (LSS) DMAIC (Define, Measure, Analyze, Improve, and Control) process was used to drive process improvement. At baseline, 15% (41 of 267) of RRHCTs were missed. After solution implementation, missed RRHCTs dropped to 4% (2 of 50). Of the 2 that were missed, zero were clinically inappropriate misses, making the postimplementation rate effectively 0%. The LSS DMAIC process helped health care professional to facilitate improved adherence to the department's practice guideline with respect to RRHCT. Adherence with this guideline can help providers identify patients with DICH, a potentially life-threatening condition.

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

Guidelines call for routine reimaging of Grade 4-5 renal injuries at 48-72h. The aim of the current study is to evaluate the clinical utility of computed tomography (CT) reimaging in high-grade renal injuries. 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. 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. 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.