Introduction

In AAST grade IV and V injuries or grade III injury with perinephric fluid, current guidelines recommend obtaining a CT scan of abdomen and pelvis with intravenous contrast, followed by a delayed excretory phase to look for collecting system injury. Our aim was to evaluate compliance with excretory phase imaging recommendations in a contemporary multi-center study of high-grade renal trauma._x000D_

Methods

From 2014 to 2016, data on high-grade renal trauma (AAST grade III-V) was gathered from 10 participating trauma centers. Demographics, trauma characteristics, management, outcomes, and imaging studies, were collected. Compliance with imaging recommendations was defined as obtaining delayed excretory images within 24 hours of admission for any grade IV or V injury, or grade III injuries with perinephric fluid, in those patients not undergoing immediate laparotomy. Follow-up images and data were reviewed to determine if there were cases of delayed diagnosis of urinary extravasation. _x000D_

Results

There were 217 high-grade renal injuries (grades III [118], IV [69], V [30]). Initial CT scans were missing in 49 patients due to: patient transfer and unavailable initial imaging (15), or immediate laparotomy (34). 168 patients had an initial CT scan for review. From these, 161 had CT findings indicating the need for excretory imaging due to perinephric fluid in grade III (98), or grade IV (48) or V (15) injury. 112 (70%) of these patients had excretory imaging within 24 hours of admission, an additional 10 (6%) had one obtained during their initial hospital stay (range 2-6 days post injury). Of the patients with excretory imaging 37 (31%) had a collecting system injury diagnosed in initial CT scan with additional 3 (2%) diagnosed in CT scans obtained later during their initial hospital stay. Overall compliance with imaging recommendations ranged between 20%-100% (median: 81%) for different centers. Of 39 patients who did not have an excretory imaging, 5 underwent a CT with excretory phase later, and 2 had a delayed diagnosis of urinary leakage._x000D_

Conclusions

There is discrepancy between centers in compliance with obtaining excretory phase CT scans for evaluation of high-grade renal trauma. Despite the variation in compliance with imaging recommendations, the rate of clinically significant delayed diagnosis of urinary extravasation is low in the overall management of high-grade renal injury. _x000D_

Funding

None