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Tytuł:
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Do we need repeated CT imaging in uncomplicated blunt renal injuries? Experiences of a high-volume urological trauma centre.
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Autorzy:
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Lindner AK; Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
Luger AK; Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
Fritz J; Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria.
Stäblein J; Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
Radmayr C; Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
Aigner F; Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
Rehder P; Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
Tulchiner G; Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
Horninger W; Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
Pichler R; Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria. .
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Źródło:
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World journal of emergency surgery : WJES [World J Emerg Surg] 2022 Jul 07; Vol. 17 (1), pp. 38. Date of Electronic Publication: 2022 Jul 07.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Original Publication: London : BioMed Central, 2006-
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MeSH Terms:
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Trauma Centers*
Wounds, Nonpenetrating*/surgery
Adult ; Female ; Humans ; Kidney/injuries ; Male ; Retrospective Studies ; Tomography, X-Ray Computed
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References:
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Contributed Indexing:
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Keywords: Blunt renal trauma; Non-operative management; Repeat imaging; Selected imaging; Selective angioembolization
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Entry Date(s):
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Date Created: 20220707 Date Completed: 20220711 Latest Revision: 20220810
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Update Code:
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20240105
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PubMed Central ID:
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PMC9264658
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DOI:
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10.1186/s13017-022-00445-9
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PMID:
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35799209
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Background: Current guidelines recommend repeat computed tomography (CT) imaging in high-grade blunt renal injury within 48-96 h, yet diagnostic value and clinical significance remain controversial. The aim of this work was to determine the possible gain of CT re-imaging in uncomplicated patients with blunt renal trauma at 48 h after injury, presenting one of the largest case series.
Methods: A retrospective database of patients admitted to our centre with isolated blunt renal trauma due to sporting injuries was analysed for a period of 20 years (2000-2020). We included only patients who underwent repeat imaging at 48 h after trauma irrespective of AAST renal injury grading (grade 1-5) and initial management. The primary outcome was intervention rates after CT imaging at 48 h in uncomplicated patients versus CT scan at the time of clinical symptoms.
Results: A total of 280 patients (mean age: 37.8 years; 244 (87.1%) male) with repeat CT after 48 h were included. 150 (53.6%) patients were classified as low-grade (grade 1-3) and 130 (46.4%) as high-grade (grade 4-5) trauma. Immediate intervention at trauma was necessary in 59 (21.1%) patients with high-grade injuries: minimally invasive therapy in 48 (81.4%) and open surgery in 11 (18.6%) patients, respectively. In only 16 (5.7%) cases, intervention was performed based on CT re-imaging at 48 h (low-grade vs. high-grade: 3.3% vs. 8.5%; p = 0.075). On the contrary, intervention rate due to clinical symptoms was 12.5% (n = 35). Onset of clinical progress was on average (range) 5.3 (1-17) days post trauma. High-grade trauma (odds ratio [OR] grade 4 vs. grade 3 , 14.62; p < 0.001; OR grade 5 vs. grade 3 , 22.88, p = 0.004) and intervention performed at the day of trauma (OR 3.22; p = 0.014) were powerful predictors of occurrence of clinical progress.
Conclusion: Our data suggest that routine CT imaging 48 h post trauma can be safely omitted for patients with low- and high-grade blunt renal injury as long as they remain clinically stable. Patients with high-grade renal injury have the highest risk for clinical progress; thus, close surveillance should be considered especially in this group.
(© 2022. The Author(s).)
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