COMPLIANCE WITH AUA GUIDELINES FOR RENAL TRAUMA IMAGING AT A LEVEL 1 TRAUMA CENTER
Renal trauma is frequently encountered by urologists, trauma surgeons, and emergency room physicians. The AUA 2014 urotrauma guidelines recommend cross sectional imaging with a delayed phase to evaluate for involvement of the collecting system. Additionally, repeat imaging for high grade injuries (AAST 4−5) is recommended. Frequently, these guidelines are overlooked as trauma surgeons or emergency room physicians order initial imaging. Our objective is to evaluate guideline compliance with renal trauma imaging at a level 1 trauma center.
This was a retrospective review of all renal trauma (AAST 1−5) patients from 2016 at Denver Health Medical Center. Data were obtained from our institutional Trauma registry.
Variables included: age, length of stay, grade of injury, appropriate imaging, urologic consultation, urologic interventions, and urologic complications. Pediatric patients and patients who were taken to the operating room before imaging were excluded. Appropriately imaged patients had to be imaged with delayed films with repeat imaging for high grade injuries.
Chart review included 55 patients with renal trauma. 14 patients were excluded due to incomplete medical records. The median age was 39 and the mean length of stay was 11.9 days. 16 of the 41 patients (39%) did not have appropriate imaging. The most common reason for inappropriate imaging was lack of delayed films. None of these patients had complications. One patient required a partial nephrectomy. Urologic consultation was obtained in 6 of the 16 patients (37.5%) who were imaged inappropriately. Three of these patients did not have repeat imaging for high grade injuries despite urologic consultation.
There was a high rate of suboptimal imaging despite our institution being experienced in trauma. The most common reason for suboptimal imaging was lack of delayed excretion phase images. Increased education and improved communication among trauma surgeons, emergency room physicians, radiologists and urologists may obviate this problem and improve quality and safety of urotrauma patients.
renal trauma; patient safety, guidelines, urotrauma
Trauma / Uretra / Urologia Reconstrutora
Denver Health - - Estados Unidos, University of Colroado - - Estados Unidos
Rodrigo Donalisio da Silva, Matheus Miranda Paiva, Fernando j Kim