Implementation and Interim Analysis of a Standardized Renal Trauma Imaging and Urinary Extravasation Management...

Area of Science:

• Urology
• Radiology
• Trauma Surgery

Background:

• The American Urological Association (AUA) recommends delayed-phase imaging (DPI) for evaluating collecting system injuries in renal trauma.
• A protocol was implemented to enhance adherence to early conservative management of urinary extravasation (UE).

Purpose of the Study:

• To assess the impact of a new renal trauma imaging protocol on guideline adherence and patient outcomes.
• To determine if improved adherence to DPI and early conservative management affects intervention rates and readmissions for UE.

Main Methods:

• Retrospective review of patients with American Association for the Surgery of Trauma (AAST) grade III-V renal injuries from January 2018 to September 2022.
• Comparison of DPI frequency and patient outcomes before and after the implementation of a multidisciplinary renal trauma imaging protocol.

Main Results:

• Adherence to DPI on admission significantly increased from 32.8% to 58.7% post-protocol (P < .001).
• Rate of follow-up imaging increased from 18.3% to 58.7% (P < .001).
• Immediate interventions for UE decreased to 0% post-protocol, with no significant changes in delayed interventions or readmissions.

Conclusions:

• The implemented protocol successfully improved adherence to AUA guidelines for renal trauma imaging and management.
• Protocol adherence eliminated immediate interventions for UE without compromising patient outcomes regarding readmissions.
• Further research is warranted to define the role of routine follow-up imaging in the conservative management of high-grade renal trauma.