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Unexpected High Rates of Angiography and Angioembolization for Isolated Low Grade Renal Trauma: Results from a Large, Statewide, Trauma Database
Urology. 2016 Nov;97 :92-97
PMID: 27261185 URL: http://www.ncbi.nlm.nih.gov/pubmed/27261185
AbstractOBJECTIVE: To evaluate usage of diagnostic angiography (DA) and renal angioembolization (RAE) for isolated renal injuries while assessing differences in utilization based on trauma-level designation. METHODS: Isolated renal injuries from 2000-2013 were identified in the prospectively maintained Pennsylvania Trauma Outcome Study (PTOS) database and stratified by American Association for the Surgery of Trauma (AAST) kidney injury grade. Therapeutic intervention and ICD-9 codes identified DA and/or RAE performance, while renal injury was designated through Abbreviated Injury Scale (AIS) codes. Univariate and multivariate models identified factors associated with utilization of DA/RAE. RESULTS: Of 449,422 patients entered into the PTOS from 2000-2013, 1628 (0.4%) isolated kidney injuries were identified. The majority of patients (1190/1628, 73.1%) experienced low-grade (AAST I-III) renal trauma. Though isolated grade IV (41/350, 11.7%) or grade V (10/88, 11.4%) renal trauma patients underwent DA/RAE at a greater rate (p<0.001), low-grade patients still underwent DA/RAE 4.3% (51/1190) of the time. Patients with grade I injuries were significantly more likely to undergo DA/RAE at level 1 trauma centers (OR 5.4, CI 1.2-23.8, p=0.03). CONCLUSIONS: Despite overwhelming evidence supporting conservative management for patients with isolated, low-grade traumatic renal injuries, contemporary utilization of DA and RAE in such patients treated at trauma centers is surprisingly high. Factors accounting for a significant increase in utilization at Level 1 trauma centers need to be further elucidated.
NotesGor, Ronak A Styskel, Brett A Li, Tianyu Canter, Daniel J Simhan, Jay Urology. 2016 May 31. pii: S0090-4295(16)30253-9. doi: 10.1016/j.urology.2016.05.042.