Wang Shirley L, Agrawal Pranjal, Rostom Mary, Gupta Nikita, Holler Albert, Pan Isabelle, Stevens Kent, Fang Raymond, Haut Elliott, Fransman Ryan, Berry Renu, Cohen Andrew J
Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD.
Division of Acute Care Surgery, Johns Hopkins Medicine, Baltimore, MD.
Urology. 2022 Dec;170:209-215. doi: 10.1016/j.urology.2022.08.024. Epub 2022 Aug 30.
To describe rates of urology consultation following renal trauma and assess subsequent impact on imaging and intervention. Renal trauma may be initially managed by either trauma or urologic surgeons alone or collaboratively. Differences in management between the specialties are not well studied.
We conducted an IRB-approved retrospective review of patients at a Level I trauma center sustaining renal trauma between 2014 and 2021. Demographic, injury, radiologic, and intervention variables were extracted. Frequencies and medians were compared using chi-squared and Fischer's exact tests or Mann-Whitney U tests, respectively. Analyses were performed using STATA with P <.05 considered significant.
From 2014 to 2021, 118 patients with median age 29 (IQR 22-41) sustained renal trauma. Urology was consulted in 18 (15.3%) cases. Demographic and injury characteristics were similar between the 2 groups. AAST renal injury grade was transcribed in the initial radiologic reports for 49 (41.5%) of patients. Those in the urology consult group were more likely to receive delayed contrast imaging during their admission (50.0% vs 17.0%, P <.01). Among those with high-grade injuries, those with urology consult were less likely to undergo nephrectomy (36.4% vs 78.8%, P = .02).
We observed differences in imaging patterns between renal trauma patients who are managed primarily by trauma surgery versus urology. However, the impact of these differences in imaging remains to be elucidated. Among patients with high-grade renal trauma, urology consult was associated with decreased rate of nephrectomy, emphasizing the feasibility of renal salvage in a multidisciplinary trauma setting.
描述肾外伤后泌尿外科会诊率，并评估其对影像学检查和干预措施的后续影响。肾外伤最初可由创伤外科医生或泌尿外科医生单独或联合处理。目前对这两个专科在治疗方式上的差异研究较少。
我们对一家一级创伤中心2014年至2021年间收治的肾外伤患者进行了一项经机构审查委员会批准的回顾性研究。提取了患者的人口统计学、损伤情况、影像学和干预变量。分别使用卡方检验、费舍尔精确检验或曼-惠特尼U检验比较频率和中位数。使用STATA进行分析，P <.05被认为具有统计学意义。
2014年至2021年期间，118例中位年龄为29岁（四分位间距22 - 41岁）的患者发生了肾外伤。其中18例（15.3%）患者接受了泌尿外科会诊。两组患者的人口统计学和损伤特征相似。49例（41.5%）患者的美国创伤外科学会（AAST）肾损伤分级记录在初始影像学报告中。接受泌尿外科会诊的患者在住院期间更有可能接受延迟增强成像检查（50.0% 对17.0%，P <.01）。在重度损伤患者中，接受泌尿外科会诊的患者接受肾切除术的可能性较小（36.4% 对78.8%，P = .02）。
我们观察到主要由创伤外科或泌尿外科处理的肾外伤患者在影像学检查模式上存在差异。然而，这些影像学差异的影响仍有待阐明。在重度肾外伤患者中，泌尿外科会诊与肾切除术发生率降低相关，这强调了在多学科创伤治疗环境中保留肾脏的可行性。
