Is routine re-imaging for high-grade renal injury needed? Retrospective analysis of 1500 abdominal trauma patients from a tertiary care trauma center over 11 years.

INTRODUCTION AND AIM

The AUA and EAU guidelines recommend re-imaging in high-grade renal trauma, regardless of the clinical findings. The aim of this study was to assess the impact of re-imaging on the overall management and outcomes in these patients.

METHODS

The trauma registry of our tertiary care Level-1 trauma center was reviewed from January 2007 till October 2018. Out of 1536 patients with abdominal trauma, 174 patients with isolated renal injury were identified. Renal injuries were classified based on the AAST classification. Variables retrieved were demographics, renal injury grade, presence of urinoma, repeated imaging findings, and intervention after initial and repeated imaging.

RESULTS

Low-grade injury was found in 78.7% (137/174) compared to 21.3% (37/174) with high-grade injury. The majority (n = 136) of low-grade patients were managed conservatively except one patient with Grade III injury required angioembolization after initial imaging. Of the high-grade patients, 31/37 were treated conservatively except 6/37 patients required surgical intervention after initial imaging. Following re-imaging, only one patient required surgical intervention in the form of insertion of a drainage tube for a hematoma, which was possibly infected. The existence of urinoma (5 patients) or hematoma (47 patients) was not associated with significantly higher rate of intervention (p values: 0.717 and 0.138, respectively). No significant association was noted between hematoma size and rate of intervention (p value = 0.055).

CONCLUSION

Re-imaging for high-grade renal injuries could be limited to the presence of urinary extravasation in initial imaging or the presence of clinical deterioration such as pain, fever or decrease in hemoglobin level.