Process improvement in trauma: traumatic bladder injuries and compliance with recommended imaging evaluation

Area of Science:

• Trauma Surgery
• Diagnostic Imaging
• Urology

Background:

• Traumatic bladder injuries require specific imaging protocols, including computed tomographic (CT) cystogram or plain cystogram.
• Compliance with these recommended imaging guidelines may be suboptimal in trauma centers.

Purpose of the Study:

• To assess compliance with recommended imaging for traumatic bladder injury.
• To determine the impact of poor compliance on the diagnosis, management, and outcomes of patients with bladder injury.

Main Methods:

• Retrospective review of patients with bladder injury from Level 1 trauma registries (1996-2010).
• Descriptive statistics, bivariate, and logistic regression analyses were used to describe presentation, management, and outcomes.
• Level of Evidence: Therapeutic study, level IV.

Main Results:

• 124 patients with bladder injury were identified; 88% resulted from blunt trauma, with pelvic fracture being the most common concomitant injury (79%).
• Intraperitoneal bladder injuries were associated with a significantly higher risk of death (OR, 12.4).
• Imaging detected 100 injuries; standard CT missed or misdiagnosed 13% of bladder injuries, particularly extraperitoneal ones.

Conclusions:

• There is poor adherence to recommended imaging protocols (CT cystogram or plain cystogram) for traumatic bladder injuries at Level 1 trauma centers.
• A genitourinary trauma imaging algorithm has been implemented to reduce diagnostic errors in bladder injury.