Presentation Authors: Sorena Keihani*, Douglas Rogers, Bryn Putbrese, Rachel Moses, Chong Zhang, Salt Lake City, UT, Kaushik Mukherjee, Loma Linda, CA, Sarah Majercik, Murray, UT, Joshua Piotrowski, Christopher Dodgion, Milwaukee, WI, Brenton Sherwood, Bradley Erickson, Iowa City, IA, Ian Schwartz, Sean Elliott, Minneapolis, MN, Erik DeSoucy, Scott Zakaluzny, Sacramento, CA, Nima Baradaran, Benjamin Breyer, San Francisco, CA, Brian Smith, Philadelphia, PA, Brandi Miller, Richard Santucci, Detroit, MI, Matthew Carrick, Plano, TX, Jurek Kocik, Tyler, TX, Timothy Hewitt, Frank Burks, Royal Oak, MI, Angela Presson, Salt Lake City, UT, Marta Heilbrun, Atlanta, GA, Raminder Nirula, James Hotaling, Jeremy Myers, Salt Lake City, UT
Introduction: Radiologic factors are important for predicting bleeding interventions after high-grade renal trauma (HGRT). We aimed to assess the associations between laceration size and peri-renal hematoma rim distance (HRD) with bleeding interventions after HGRT and also find the optimal cut-off points for these measurements.
Methods: The Genito-Urinary Trauma Study is a multi-center study including data on HGRT (AAST grades III-V) from 14 Level-1 trauma centers from 2014-2017. Patients with initial CT scans were included. 2 radiologists reviewed the scans to extract HRD (largest measure from the edge of the kidney to the hematoma in the axial plane) and size of the deepest laceration. Renal bleeding interventions included: angioembolization, surgical packing, renorrhaphy, partial nephrectomy, and nephrectomy. Diagnostic accuracy was measured using the ROC analysis and the optimal cut-offs were chosen based on the Youden&[prime]s index and F-1 score. Mixed effect Poisson regression was used to assess the associations.
Results: 326 patients were included. Mean age was 35.0Â±16.6 y. Injury mechanism was blunt in 81%. Injuries were reported as AAST grades III (60%), IV (33%), and V (7%). Overall, 47 (14%) underwent bleeding interventions including 19 renal angioembolization, 16 nephrectomies, and 12 other procedures. Mean HRD was 2.1Â±2.0 cm and was higher in the intervention group (4.3Â±0.4 vs. 1.8Â±0.1, P < 0.001). Mean laceration size was 2.0Â±1.0 cm and was higher in the intervention group (2.8Â±0.1 vs. 1.9Â±0.1, P < 0.001). For HRD, a cut-off of 3.5 cm provided the best diagnostic accuracy (sen: 0.62, spe: 0.87, Youden: 0.49, F1 score: 0.51). An HRD â‰¥3.5 cm was associated with 6.3-fold increase in risk of undergoing bleeding interventions (RR: 6.3, 95% CI: 3.5-11.4). For laceration size, a cut-off of 2.5 cm provided best diagnostic accuracy (sen: 0.62, spe: 0.80, Youden: 0.42, F1 score: 0.44). A laceration â‰¥2.5 cm was associated with 4.4-fold increased risk of bleeding interventions (RR: 4.4, 95% CI: 2.5-8.0).
Conclusions: Our findings support the use of 3.5 cm cut-off point for hematoma and 2.5 cm for laceration size. These cut-offs may be used as simpler predictors of bleeding interventions. Renal trauma grading may benefit from incorporating additional important radiologic findings.