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The associations between initial radiographic findings and interventions for renal hemorrhage after high-grade renal trauma

Results from the Multi-Institutional Genitourinary Trauma Study

Keihani, Sorena MD; Putbrese, Bryn E. MD; Rogers, Douglas M. MD; Zhang, Chong MS; Nirula, Raminder MD; Luo-Owen, Xian PhD; Mukherjee, Kaushik MD; Morris, Bradley J. RN; Majercik, Sarah MD, MBA; Piotrowski, Joshua MD, PhD; Dodgion, Christopher M. MD, MSPH; Schwartz, Ian MD; Elliott, Sean P. MD, MS; DeSoucy, Erik S. DO; Zakaluzny, Scott MD; Sherwood, Brenton G. MD; Erickson, Bradley A. MD, MS; Baradaran, Nima MD; Breyer, Benjamin N. MD, MAS; Fick, Cameron N. MS; Smith, Brian P. MD; Okafor, Barbara U. MBA; Askari, Reza MD; Miller, Brandi DO; Santucci, Richard A. MD; Carrick, Matthew M. MD; Kocik, Jurek F. MD; Hewitt, Timothy MD; Burks, Frank N. MD; Heilbrun, Marta E. MD; Myers, Jeremy B. MD in conjunction with the Trauma and Urologic Reconstruction Network of Surgeons

Journal of Trauma and Acute Care Surgery: June 2019 - Volume 86 - Issue 6 - p 974–982
doi: 10.1097/TA.0000000000002254

BACKGROUND Indications for intervention after high-grade renal trauma (HGRT) remain poorly defined. Certain radiographic findings can be used to guide the management of HGRT. We aimed to assess the associations between initial radiographic findings and interventions for hemorrhage after HGRT and to determine hematoma and laceration sizes predicting interventions.

METHODS The Genitourinary Trauma Study is a multicenter study including HGRT patients from 14 Level I trauma centers from 2014 to 2017. Admission computed tomography scans were categorized based on multiple variables, including vascular contrast extravasation (VCE), hematoma rim distance (HRD), and size of the deepest laceration. Renal bleeding interventions included angioembolization, surgical packing, renorrhaphy, partial nephrectomy, and nephrectomy. Mixed-effect Poisson regression was used to assess the associations. Receiver operating characteristic analysis was used to define optimal cutoffs for HRD and laceration size.

RESULTS In the 326 patients, injury mechanism was blunt in 81%. Forty-seven (14%) patients underwent 51 bleeding interventions, including 19 renal angioembolizations, 16 nephrectomies, and 16 other procedures. In univariable analysis, presence of VCE was associated with a 5.9-fold increase in risk of interventions, and each centimeter increase in HRD was associated with 30% increase in risk of bleeding interventions. An HRD of 3.5 cm or greater and renal laceration depth of 2.5 cm or greater were most predictive of interventions. In multivariable models, VCE and HRD were significantly associated with bleeding interventions.

CONCLUSION Our findings support the importance of certain radiographic findings in prediction of bleeding interventions after HGRT. These factors can be used as adjuncts to renal injury grading to guide clinical decision making.

LEVEL OF EVIDENCE Prognostic and Epidemiological Study, Level III and Therapeutic/Care Management, Level IV.

From the Division of Urology, Department of Surgery (S.K., J.B.M.), Department of Radiology (B.E.P., D.M.R.), Division of Epidemiology, Department of Internal Medicine (C.Z.), Department of Surgery (R.N.), University of Utah, Salt Lake City, Utah; Division of Acute Care Surgery (X. L-O, K.M), Loma Linda University Medical Center, Loma Linda, California; Division of Trauma and Surgical Critical Care (B.J.M., S.M), Intermountain Medical Center, Murray, Utah; Department of Urology (J.P.), Department of Surgery (C.M.D.), University of Wisconsin, Milwaukee, Wisconsin; Department of Urology (I.S., S.P.E.), Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota; Department of Surgery (E.S.D.); Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery (S.Z.), University of California Davis Medical Center, Sacramento, California; Department of Urology (B.G.S., BA.E), University of Iowa, Iowa City, Iowa; Department of Urology (N.B., B.N.B.), University of California-San Francisco, San Francisco, California; Division of Trauma and Surgical Critical Care (C.N.F., B.P.S), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Trauma, Department of Surgery (B.U.O., R.A.), Brigham and Women's Hospital, Boston, Massachusetts; Department of Urology (B.M., R.A.S), Detroit Medical Center, Detroit, Michigan; Medical City Plano (M.M.C.), Plano; Department of Surgery (J.F.K.), East Texas Medical Center, Tyler, Texas; Department of Urology (T.H., F.N.B.), Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; Department of Radiology and Imaging Sciences (M.E.H.), Emory University Hospital, Atlanta, Georgia.

Submitted: January 24, 2019, Accepted: February 20, 2019, Published online: March 11, 2019.

Address for reprints: Sorena Keihani, MD, Division of Urology, Department of Surgery University of Utah School of Medicine 30 North 1900 East, Salt Lake City, UT 84132; email:

This abstract of this work is accepted for presentation at the 114th Annual Meeting of the American Urological Association (AUA), 3–6 May 2019, Chicago, IL.

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© 2019 Lippincott Williams & Wilkins, Inc.