CLINICAL PREDICTORS OF IMMEDIATE INTERVENTION FOLLOWING EMERGENCY ROOM (ER) PRESENTATION WITH ISOLATED RENAL TRAUMA

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II1 Apr 2018MP25-12 CLINICAL PREDICTORS OF IMMEDIATE INTERVENTION FOLLOWING EMERGENCY ROOM (ER) PRESENTATION WITH ISOLATED RENAL TRAUMA Jacob Lucas, Matthew Brennan, Brett Styskel, Ronak Gor, Tianyu Li, Steven Sterious, Robert Uzzo, and Jay Simhan Jacob LucasJacob Lucas More articles by this author , Matthew BrennanMatthew Brennan More articles by this author , Brett StyskelBrett Styskel More articles by this author , Ronak GorRonak Gor More articles by this author , Tianyu LiTianyu Li More articles by this author , Steven SteriousSteven Sterious More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Jay SimhanJay Simhan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.849AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite AAST recommendations for conservative treatment of low-grade renal traumas (grades I–III), recent evidence suggests overutilization of renal angioembolization and/or surgery for the management of these injuries. Utilizing the largest prospectively maintained statewide trauma registry, we identified factors resulting in immediate intervention for isolated renal trauma based upon initial presentation in the ER. METHODS The PA Trauma Systems Foundation’s statewide trauma registry was queried for trauma patients presenting to level I or II trauma centers with isolated renal injuries (Grades I–V) from 2000-2013. Patient demographics, mechanism, AAST grade, trauma center level designation, presenting ER vital signs (heart rate, HR; respiratory rate, RR; systolic blood pressure, SBP), intubation status, and blood product transfusion were assessed. Multivariate logistic regression identified independent predictors of immediate intervention. RESULTS Of 449,422 patients, 1628 (0.4%) isolated renal injuries were identified and 1430 patients (77% male, median age 29 yrs [range 2-92]) had data available for analysis. Controlling for demographics, presenting ER vital signs, GCS, trauma center level, mechanism and intubation status, level I status (OR 2.24 [1.49-3.39], p=0.0001), penetrating mechanism (OR 7.87 [4.73-13.07], p<0.0001), AAST IV/V injury (OR 8.74 [6.36-12.00], p<0.0001) and blood product administration (OR 2.62 [1.46-4.70], p=0.0013) were independently associated with any immediate intervention following ER presentation (Table 1). Independent predictors of immediate surgical intervention included level I status (OR 2.37 [1.32-4.25], p=0.0039), AAST IV/V injury (OR 13.31 [8.62-20.55], p<0.0001), and clinical hypotension (SBP <95 mmHg, OR 2.10 [1.08-4.09], p=0.029). CONCLUSIONS Query of the nation’s largest statewide trauma database revealed that Level 1 trauma center designation, penetrating mechanism of injury, high-grade injury, and clinical hypotension were all independent predictors of immediate surgical intervention for isolated renal traumas. Level 1 trauma center designation continues to be a predictor of any intervention, regardless of AAST trauma grade. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e331 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jacob Lucas More articles by this author Matthew Brennan More articles by this author Brett Styskel More articles by this author Ronak Gor More articles by this author Tianyu Li More articles by this author Steven Sterious More articles by this author Robert Uzzo More articles by this author Jay Simhan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...