Presentations

Abstract

Introduction: Delayed-phase CT (DPCT) after high-grade renal trauma is universally recommended to evaluate for collecting system injuries and urinary extravasation (UE). We aim to investigate the impact of DPCT on urological intervention rates and the consequences of undetected UE on length of stay.

Methods: This retrospective cohort study analyzed all patients with an AAST grade I-V renal injury at a Level 1 Trauma Center from 2018-2023. High-grade trauma was classified as AAST grades III-V. Patients were identified using the institutional trauma registry and data was collected from the registry and electronic medical records. Risk adjusted multivariate logistic regression was employed to analyze the impact of undergoing DPCT on urological intervention rates while controlling for ISS, AAST grade, age, sex, race, and mechanism. Risk adjusted multivariate linear regression was used to analyze the impact of late UE detection on length of stay (LOS), controlling for age, sex, race, ISS, arrival condition, concomitant abdominal injuries, comorbidities, and emergency department disposition.

Results: Of 255 renal trauma patients, 163 (63.4%) suffered high-grade injuries. 34 patients underwent immediate DPCT, with 6 patients having UE and 5 receiving subsequent urological intervention. 33 patients underwent follow-up DPCT, with 7 patients having UE and 6 receiving interventions. At follow-up DPCT, zero patients had UE if they were asymptomatic, defined as lack of leukocytosis, fever, flank pain, oliguria, and hematuria (NPV = 100%). Additionally, all 6 patients who had UE at follow-up were symptomatic (sensitivity = 100%). After performing risk adjusted multivariate logistic regression, patients who had DPCT were 13.9 times as likely to undergo urological intervention factors associated with undergoing a urological procedure were DPCT (OR 13.9, p = 0.001). Importantly, late detection of UE, defined as UE not detected on admission DPCT, was significantly associated with increased length of stay (β = 10.63, p = 0.048).

Conclusion: Patients who did not undergo DPCT had significantly lower rates of urological intervention, despite similar injury burden. Follow-up DPCT may potentially be safely omitted in asymptomatic patients, but admission DPCT should still be utilized in high-grade injuries to avoid the significant morbidity of undetected urinary extravasation.