Abstract: PD63-07
Sources of Funding: AHS Surgery Strategic Clinical Network Summer Surgical Research Studentship (SSRS) Award

Introduction

Although the American Association of the Surgery for Trauma Organ Injury Scale (AAST-OIS) can help predict the need for urologic intervention, this grading system does not include other potentially important factors such as devitalized renal fragments, laceration location and perinephric hematoma characteristics. The objective of this study is to examine predictors of urologic intervention in the setting of blunt renal trauma.

Methods

The Alberta Trauma Registry was used to identify renal trauma patients at the University of Alberta from October 2004-December 2014. Penetrating trauma and patients without complete datasets were excluded from analysis. Hospital records and diagnostic imaging were reviewed to identify the need for intervention related to the renal injury including ureteral stenting, percutaneous drainage, angiographic embolization, nephrectomy or renorraphy. Clinical and radiographic factors examined included patient age, gender, length of stay, ISS, AAST-OIS grade, laceration length/number, perinephric hematoma characteristics (number, length, location, area), intravascular contrast excretion (ICE) and devitalized segment status. Descriptive statistics and binary logistic regression were performed where appropriate.

Results

328 patients with blunt renal trauma met study criteria. Mean patient age was 37.0 years with a mean ISS of 31.7. 27 patients (8.2%) required a total of 31 interventions including ureteral stenting (38.7%; 12/31), angiographic embolization (32.3%; 10/31), nephrectomy (22.6%; 7/31), renorraphy (3.2%; 1/31) and percutaneous drainage (3.2%; 1/31). On univariate analysis AAST grade (p<0.001), hematoma diameter (p<0.001), hematoma area (p<0.001), ICE (p<0.001), laceration length (p<0.001), laceration number (p<0.001), devitalized fragment presence (p<0.0001) and degree of devitalization (p<0.001) were associated with the need for intervention. On multivariate regression analysis only AAST grade (p<0.001; O.R. 69.4; 95%C.I. 6.4-748.3), hematoma diameter (p=0.004; O.R.1.5; 95%C.I. 1.1-1.9) and/or hematoma area (p=0.012; O.R. 1.03; 95% C.I. 1.01-1.06) remained associated with the need for intervention.

Conclusions

Although the AAST-OIS is strongly associated with the need for urologic intervention, perinephric hematoma diameter and area are also independently associated with this occurrence. Perinephric hematoma size should be considered during clinical decision-making and should be incorporated into a revised injury grading system.

Funding

AHS Surgery Strategic Clinical Network Summer Surgical Research Studentship (SSRS) Award