Pd12-02 urinary extravasation after renal trauma: should it be a criterion for the american association for surgery of trauma (aast) grade iv injury?

You have accessJournal of UrologyCME1 Apr 2023PD12-02 URINARY EXTRAVASATION AFTER RENAL TRAUMA: SHOULD IT BE A CRITERION FOR THE AMERICAN ASSOCIATION FOR SURGERY OF TRAUMA (AAST) GRADE IV INJURY? Sorena Keihani, Douglas Rogers, Sherry Wang, Joel Gross, Ryan Joyce, Judith Hagedorn, J. Patrick Selph, Rachel Moses, Rachel Sensenig, Joshua Broghammer, Shubham Gupta, Nima Baradaran, and Jeremy Myers Sorena KeihaniSorena Keihani More articles by this author , Douglas RogersDouglas Rogers More articles by this author , Sherry WangSherry Wang More articles by this author , Joel GrossJoel Gross More articles by this author , Ryan JoyceRyan Joyce More articles by this author , Judith HagedornJudith Hagedorn More articles by this author , J. Patrick SelphJ. Patrick Selph More articles by this author , Rachel MosesRachel Moses More articles by this author , Rachel SensenigRachel Sensenig More articles by this author , Joshua BroghammerJoshua Broghammer More articles by this author , Shubham GuptaShubham Gupta More articles by this author , Nima BaradaranNima Baradaran More articles by this author , and Jeremy MyersJeremy Myers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003259.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary extravasation (UE) is a main criterion for grade IV renal trauma. An appropriately-timed excretory phase CT is needed for accurate diagnosis. We aimed to assess the compliance with excretory phase imaging in a multi-center study and evaluate the management of UE after high-grade renal trauma (HGRT). METHODS: We used HGRT data from 7 Level-1 trauma centers. Patients with CT scans were included. Demographics, injury and imaging characteristics, and interventions were reviewed. We assessed compliance with obtaining excretory phase CT and its timing (9 minutes delay considered as adequate), and the rate of interventions for UE. We defined UE information as Ux (unknown/excretory imaging not done), U0 (no UE in excretory imaging), and U1 (UE present). RESULTS: We reviewed data from 550 patients with HGRT (grades III: 284 [51.5%]; IV: 250 [45.5%]; V: 16 [3%]) according to the 2018 AAST grading system. Only 324 (59%) had excretory phase images available within the initial CT to assess for UE with compliance rates between 26% to 100% between different centers. The median time between the arterial and delayed phase was 8 minutes (IQR: 4–11); 51% of the excretory images were inadequately timed (<9 minutes). Overall, 94 (17%) were diagnosed with UE either initially (n=62) or in follow up images (n=32). Of these, 22 (23%) underwent ureteral stent placement and 5 (5%) received peri-renal drains. Of the 262 with U0, 21 had UE diagnosed in follow up studies (8% missed UE with initial excretory imaging). Of the 226 with Ux, 11 were diagnosed with UE in follow up imaging (5% missed UE without initial excretory imaging). 59 of 94 patients with UE (63%) would have been grade IV only due to UE. Compared to the other patients with UE, these had lower rates of bleeding interventions (8% vs. 31%), active bleeding, and had smaller hematoma and lacerations sizes. CONCLUSIONS: About 40% of those with HGRT did not undergo excretory phase imaging in the initial assessment. The compliance in obtaining these images and the timing were variable and suboptimal. These can lead to inaccurate and incomplete grading of renal injuries in regards to UE. UE status can be provided as separate information or be included under grade III renal injuries. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e400 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sorena Keihani More articles by this author Douglas Rogers More articles by this author Sherry Wang More articles by this author Joel Gross More articles by this author Ryan Joyce More articles by this author Judith Hagedorn More articles by this author J. Patrick Selph More articles by this author Rachel Moses More articles by this author Rachel Sensenig More articles by this author Joshua Broghammer More articles by this author Shubham Gupta More articles by this author Nima Baradaran More articles by this author Jeremy Myers More articles by this author Expand All Advertisement PDF downloadLoading ...