Login to Access Video or Poster Abstract: MP24-20
Sources of Funding: none

Introduction

Non-operative management (NOM) is the standard of care for blunt renal trauma. Observation for blunt renal trauma has been widely adopted with practitioner dependent duration of bed rest. A paucity of data exists regarding the effect of bed rest on outcomes and on hospital length of stay (LOS). Urologists commonly offer either bed rest for four to five days or until the resolution of gross hematuria._x000D_ Given the system-wide emphasis on reducing LOS, we sought to prospectively determine if early ambulation leads to shorter hospital stays and its safety for patients with grade 2-4 blunt renal trauma._x000D_

Methods

After obtaining IRB approval and consent from patients with Grade 2-4 renal laceration, patients were randomized to either four days of strict bed rest or strict bed rest until resolution of hematuria. Primary end-point was hospital LOS while intervention performed, complications, and rate of re-bleed was also collected. The study was closed due to failure to accrue._x000D_

Results

From Aug 2012 - Sep 2015, 12 patients were randomized into one of the two groups. The bed rest group consisted of four patients while the early ambulation group consisted of eight. Median age overall was 23.5, with 22.99 in the bed rest and 25.61 in the early ambulation group (p=0.8). Overall, 3 were female (25%) and 9 were male (75%). The cohort consisted of one Grade 2 (8.3%), eight Grade 3 (66.7%), and three Grade 4 (25.0%) renal lacerations. _x000D_ Median time to ambulation was 2 days, with 5 and 1.5 days for bed rest and early groups, respectively (p<0.01). Median LOS was 4.0 days with 6.0 days and 3.0 days for the bed rest and early groups, respectively (p<0.05)._x000D_ No re-bleeds were documented in either group and no interventions were required for the early ambulation group. Two patients in the bed rest arm required angiography without other intervention and one required a blood transfusion. One patient acquired a catheter associated urinary tract infection._x000D_

Conclusions

Strict bed rest protocols are associated with higher morbidity due to prolonged immobilization and the subsequent increase in LOS exposure iatrogenic morbidity and cost. Albiet a small sample size, our data illustrate Level 1 evidence that early ambulation yields decreased hospital LOS without causing adverse side effects. _x000D_

Funding

none