Login to Access Video or Poster Abstract: MP79-18
Sources of Funding: This research was supported in part by the Proposed Research Initiated by Students and Mentors (PRISM) Program, University of Maryland School of Medicine Office of Student Research.

Introduction

Missed or delayed diagnoses of concurrent bladder damage in a patient with blunt urethral trauma can lead to a high rate of morbidity. A proven prognostic indicator to evaluate the likelihood of bladder injury in this patient population has not yet been established, but would be beneficial in determining care. The aim of this study was to determine if there was a clinically useful association between the Injury Severity Score (ISS) and bladder involvement among patients with blunt urethral trauma.

Methods

Retrospective analysis was performed on a cohort of 98 patients who had presented with blunt urethral trauma to R. Adams Cowley Shock Trauma Center between the years of 2002-2014. Univariate analysis was performed to determine if there was an association between concurrent bladder injuries and a variety of factors including ISS, Trauma Injury Severity Score (TRISS), age, pelvic fracture, and complete urethral distraction. A receiver operating characteristic plot was also performed to analyze the association between ISS and bladder involvement.

Results

Of the 98 patients with blunt urethral trauma, 28 of them had concurrent bladder injury. ISS was shown to have a significant correlation with concurrent bladder injury with and odds ratio of 2.2 for every 10 point increase in ISS (p=0.0001). Receiver operating characteristics curve analysis showed an area under the curve of 0.76 as shown in Figure 1. Furthermore, patients with an ISS ≥34 had a 54% chance of bladder involvement, while patients with an ISS <34 had a 13% chance of involvement. None of the other factors analyzed showed significance (p>0.05).

Conclusions

An ISS≥34 may be a reliable clinical indicator of bladder injury in patients presenting with blunt urethral trauma. This added information could be used in determining which patients receive additional imaging. Advantages of using ISS in this manner include high utility and ease of implementation.

Funding

This research was supported in part by the Proposed Research Initiated by Students and Mentors (PRISM) Program, University of Maryland School of Medicine Office of Student Research.