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

• Published in: Urology practice p. 101097UPJ0000000000000669
• Main Authors: Chisholm, Leah, Koch, George E, Huang, Jennifer J, Bhalla, Rohan G, Ayangbesan, Abimbola, Walton, William J, Dennis, Bradley M, Guillamondegui, Oscar, Johnsen, Niels V
• Format: Journal Article
• Language: English
• Published: United States 16.07.2024
• Subjects: delayed-phase imaging; guidelines; high-grade renal trauma; urinary extravasation
• ISSN: 2352-0787; 2352-0787
• DOI: 10.1097/UPJ.0000000000000669

The AUA recommends delayed-phase imaging (DPI) in renal injuries to evaluate the collecting system. A renal trauma imaging protocol for early conservative management of urinary extravasation (UE) was implemented to improve guideline adherence. We aimed to determine if increased adherence led to changes in outcomes. Patients with American Association for the Surgery of Trauma III to V renal injury presenting from January 2018 to September 2022 were identified from an institutional trauma registry. Patients were included if a contrasted CT scan of the abdomen was obtained on admission. Frequency of DPI and patient outcomes were compared before and after protocol implementation. Of 223 included patients, 131 (58.7%) were pre protocol and 92 (41.3%) were post protocol. Following protocol implementation, the rate of DPI on admission nearly doubled from 32.8% to 58.7% ( < .001). The rate of follow-up cross-sectional imaging increased from 18.3% to 58.7% ( < .001). Although there were no significant differences in rates of immediate or delayed interventions following protocol implementation, the postprotocol immediate intervention rate did decrease to 0%. Readmissions due to symptomatic UE were unchanged after protocol implementation (0.0% vs 0.0%). Implementation of a multidisciplinary renal trauma early imaging and management protocol improved AUA guideline adherence. With protocol adherence, there was also an elimination of immediate interventions for UE. Despite decreases in early intervention, there was no significant increase in interval interventions or UE-related readmissions. More research is needed to determine the role for routine follow-up imaging in conservative management of high-grade renal trauma.