Glass Allison S, Appa Ayesha A, Kenfield Stacey A, Bagga Herman S, Blaschko Sarah D, McGeady James B, McAninch Jack W, Breyer Benjamin N
Department of Urology, University of California San Francisco, 400 Parnassus Ave, Suite A-610, San Francisco, CA, 94143, USA,
World J Urol. 2014 Jun;32(3):821-7. doi: 10.1007/s00345-013-1169-1. Epub 2013 Sep 27.
A variety of clinical and imaging findings are used by clinicians to determine utility of renal angioembolization (AE) in managing renal trauma. Our purpose was to investigate specific criteria that clinicians who manage high-grade renal trauma (HGRT) utilize in decision-making for primary or delayed AE.
A total of 413 urologists and interventional radiologists (IRs) who practice at level 1 or 2 trauma centers within the United States were provided an original survey via email on experience and opinions regarding the utility of AE for HGRT. We described overall practice patterns and assessed differences by clinician type, using the Fisher's exact test.
A total of 79 (20 %) clinicians completed the survey. All clinicians had AE capability for HGRT management. A higher proportion of IRs reported using AE for grade I-II (33 vs. 3 %, p = 0.002), grade III (65 vs. 26 %, p = 0.001), and penetrating injuries (83 vs. 58 %, p = 0.02). A greater proportion of urologists reported using AE for grade V injuries (81 vs. 56 %, p = 0.03). Clinicians most commonly cited computed tomography evidence of active arterial bleeding (97 %), or arteriovenous fistula/pseudoaneurysm (94 %) as indications for primary AE, and 62 % identified concurrent visceral injury as factor that would necessitate surgical intervention.
In a survey of clinicians, we report that IRs and urologists utilize AE differently when managing HGRT, as a higher proportion of IRs use AE to manage lower grade as well as penetrating injuries. Validation studies are needed to establish algorithms to identify patients with HGRT who would benefit from selective renal AE.
临床医生运用多种临床及影像学检查结果来判定肾血管栓塞术（AE）在处理肾创伤中的实用性。我们的目的是探究处理重度肾创伤（HGRT）的临床医生在决定进行一期或延迟AE时所采用的具体标准。
通过电子邮件向在美国一级或二级创伤中心执业的413名泌尿科医生和介入放射科医生（IR）发送了一份关于AE在HGRT中实用性的经验和观点的原始调查问卷。我们描述了总体实践模式，并使用Fisher精确检验评估临床医生类型之间的差异。
共有79名（20%）临床医生完成了调查。所有临床医生都具备处理HGRT的AE能力。较高比例的IR报告称使用AE处理Ⅰ-Ⅱ级创伤（33%对3%，p = 0.002）、Ⅲ级创伤（65%对26%，p = 0.001）以及穿透伤（83%对58%，p = 0.02）。较高比例的泌尿科医生报告称使用AE处理Ⅴ级创伤（81%对56%，p = 0.03）。临床医生最常将计算机断层扫描显示的活动性动脉出血（97%）或动静脉瘘/假性动脉瘤（94%）作为一期AE的指征，62%的人认为并发内脏损伤是需要进行手术干预的因素。
在对临床医生的一项调查中，我们报告称IR和泌尿科医生在处理HGRT时对AE的使用方式不同，因为较高比例的IR使用AE处理较低级别的创伤以及穿透伤。需要进行验证研究以建立算法，来识别能从选择性肾AE中获益的HGRT患者。
