TY - JOUR
T1 - Optimal timing of delayed excretory phase computed tomography scan for diagnosis of urinary extravasation after high-grade renal trauma
AU - Keihani, Sorena
AU - Putbrese, Bryn E.
AU - Medicine, University
AU - Patel, Darshan P.
AU - Stoddard, Gregory J.
AU - Hotaling, James M.
AU - Nirula, Raminder
AU - Luo-Owen, Xian
AU - Mukherjee, Kaushik
AU - Morris, Bradley J.
AU - Majercik, Sarah
AU - Piotrowski, Joshua
AU - Dodgion, Christopher M.
AU - Schwartz, Ian
AU - Elliott, Sean P.
AU - Desoucy, Erik S.
AU - Zakaluzny, Scott
AU - Sherwood, Brenton G.
AU - Erickson, Bradley A.
AU - Baradaran, Nima
AU - Breyer, Benjamin N.
AU - Fick, Cameron N.
AU - Smith, Brian P.
AU - Okafor, Barbara U.
AU - Askari, Reza
AU - Miller, Brandi
AU - Santucci, Richard A.
AU - Carrick, Matthew M.
AU - Kocik, Jurek F.
AU - Hewitt, Timothy
AU - Burks, Frank N.
AU - Heilbrun, Marta E.
AU - Myers, Jeremy B.
N1 - Funding Information:
The authors declare no conflicts of interest. This study was not directly supported by any industrial or federal funds. The investigation was in part supported by the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 5UL1TR001067–05 (formerly 8UL1TR000105 and UL1RR025764).
Publisher Copyright:
© 2018 American Association for the Surgery of Trauma.
PY - 2019/2/1
Y1 - 2019/2/1
N2 - BACKGROUND: Excretory phase computed tomography (CT) scan is used for diagnosis of renal collecting system injuries and accurate grading of high-grade renal trauma. However, optimal timing of the excretory phase is not well established. We hypothesized that there is an association between excretory phase timing and diagnosis of urinary extravasation and aimed to identify the optimal excretory phase timing for diagnosis of urinary extravasation.METHODS: The Genito-Urinary Trauma Study collected data on high-grade renal trauma (grades III-V) from 14 Level I trauma centers between 2014 and 2017. The time between portal venous and excretory phases at initial CT scans was recorded. Poisson regression was used to measure the association between excretory phase timing and diagnosis of urinary extravasation. Predictive receiver operating characteristic analysis was used to identify a cutoff point optimizing detection of urinary extravasation.RESULTS: Overall, 326 patients were included; 245 (75%) had excretory phase CT scans for review either initially (n = 212) or only at their follow-up (n = 33). At initial CT with excretory phase, 46 (22%) of 212 patients were diagnosed with urinary extravasation. Median time between portal venous and excretory phases was 4 minutes (interquartile range, 4-7 minutes). Time of initial excretory phase was significantly greater in those diagnosed with urinary extravasation. Increased time to excretory phase was positively associated with finding urinary extravasation at the initial CT scan after controlling for multiple factors (risk ratio per minute, 1.15; 95% confidence interval, 1.09-1.22; p < 0.001). The optimal delay for detection of urinary extravasation was 9 minutes.CONCLUSION: Timing of the excretory phase is a significant factor in accurate diagnosis of renal collecting system injury. A 9-minute delay between the early and excretory phases optimized detection of urinary extravasation.LEVEL OF EVIDENCE: Diagnostic tests/criteria study, level III.
AB - BACKGROUND: Excretory phase computed tomography (CT) scan is used for diagnosis of renal collecting system injuries and accurate grading of high-grade renal trauma. However, optimal timing of the excretory phase is not well established. We hypothesized that there is an association between excretory phase timing and diagnosis of urinary extravasation and aimed to identify the optimal excretory phase timing for diagnosis of urinary extravasation.METHODS: The Genito-Urinary Trauma Study collected data on high-grade renal trauma (grades III-V) from 14 Level I trauma centers between 2014 and 2017. The time between portal venous and excretory phases at initial CT scans was recorded. Poisson regression was used to measure the association between excretory phase timing and diagnosis of urinary extravasation. Predictive receiver operating characteristic analysis was used to identify a cutoff point optimizing detection of urinary extravasation.RESULTS: Overall, 326 patients were included; 245 (75%) had excretory phase CT scans for review either initially (n = 212) or only at their follow-up (n = 33). At initial CT with excretory phase, 46 (22%) of 212 patients were diagnosed with urinary extravasation. Median time between portal venous and excretory phases was 4 minutes (interquartile range, 4-7 minutes). Time of initial excretory phase was significantly greater in those diagnosed with urinary extravasation. Increased time to excretory phase was positively associated with finding urinary extravasation at the initial CT scan after controlling for multiple factors (risk ratio per minute, 1.15; 95% confidence interval, 1.09-1.22; p < 0.001). The optimal delay for detection of urinary extravasation was 9 minutes.CONCLUSION: Timing of the excretory phase is a significant factor in accurate diagnosis of renal collecting system injury. A 9-minute delay between the early and excretory phases optimized detection of urinary extravasation.LEVEL OF EVIDENCE: Diagnostic tests/criteria study, level III.
KW - Renal trauma
KW - computed tomography
KW - multicenter study
KW - trauma centers
KW - urinary extravasation
KW - wounds and injuries
KW - Predictive Value of Tests
KW - Tomography, X-Ray Computed/methods
KW - Humans
KW - Middle Aged
KW - Male
KW - Urinary Incontinence/diagnostic imaging
KW - Injury Severity Score
KW - Wounds, Nonpenetrating/complications
KW - Adult
KW - Female
KW - ROC Curve
KW - Kidney/injuries
UR - https://www.scopus.com/pages/publications/85057170863
UR - https://www.scopus.com/pages/publications/85057170863#tab=citedBy
UR - https://www.mendeley.com/catalogue/2adc0151-dedb-35a7-a5dc-cb52ca4fbff9/
U2 - 10.1097/TA.0000000000002098
DO - 10.1097/TA.0000000000002098
M3 - Article
C2 - 30605143
SN - 2163-0755
VL - 86
SP - 274
EP - 281
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 2
ER -