Does routine repeat imaging for blunt high-grade renal trauma lead to unnecessary interventions?

Area of Science:

• Urology
• Trauma Surgery
• Radiology

Background:

• High-grade renal injuries with urinary extravasation (UE) are often managed conservatively.
• Current guidelines recommend repeat imaging within 48-72 hours for these patients.
• The association between routine follow-up imaging and clinical outcomes needs further investigation.

Purpose of the Study:

• To determine if routine, proactive follow-up renal imaging influences the need for urologic intervention.
• To assess the risk of complications associated with routine follow-up imaging in renal trauma patients.
• To evaluate the necessity of repeat imaging in managing grade IV renal injuries with UE.

Main Methods:

• Retrospective review of patients with American Association for the Surgery of Trauma grade IV renal injuries and UE.
• Inclusion criteria: blunt trauma, no immediate surgery, no in-hospital mortality.
• Data collected from a prospectively maintained trauma registry (2005-2017).

Main Results:

• Of 108 eligible patients, 23% required urologic intervention (24 endoscopic, 1 nephrectomy).
• Routine repeat imaging (65% of patients) was associated with a higher rate of subsequent urologic procedures (31.4% vs. 7.1%, p=0.008).
• Patients undergoing routine imaging had more CT scans (2.5 vs. 1.7) but similar complication rates.

Conclusions:

• Routine repeat imaging in asymptomatic patients with grade IV renal lacerations and UE may lead to unnecessary interventions.
• Forgoing repeat imaging did not increase urological complications.
• Repeat imaging may be avoidable in the absence of symptoms, reducing radiation exposure.