Optimal timing of delayed excretory phase computed tomography scan for diagnosis of urinary extravasation after high-grade renal trauma

Sorena Keihani, Bryn E. Putbrese, Douglas M. Rogers, Darshan P. Patel, Gregory J. Stoddard, James M. Hotaling, Raminder Nirula, Xian Luo-Owen, Kaushik Mukherjee, Bradley J. Morris, Sarah Majercik, Joshua Piotrowski, Christopher M. Dodgion, Ian Schwartz, Sean Elliott, Erik S. Desoucy, Scott Zakaluzny, Brenton G. Sherwood, Bradley A. Erickson, Nima BaradaranBenjamin N. Breyer, Cameron N. Fick, Brian P. Smith, Barbara U. Okafor, Reza Askari, Brandi Miller, Richard A. Santucci, Matthew M. Carrick, Jurek F. Kocik, Timothy Hewitt, Frank N. Burks, Marta E. Heilbrun, Jeremy B. Myers

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)274-281
Number of pages8
JournalJournal of Trauma and Acute Care Surgery
Volume86
Issue number2
DOIs
StatePublished - Feb 1 2019

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Keywords

  • Renal trauma
  • computed tomography
  • multicenter study
  • trauma centers
  • urinary extravasation
  • wounds and injuries

Cite this

Keihani, S., Putbrese, B. E., Rogers, D. M., Patel, D. P., Stoddard, G. J., Hotaling, J. M., Nirula, R., Luo-Owen, X., Mukherjee, K., Morris, B. J., Majercik, S., Piotrowski, J., Dodgion, C. M., Schwartz, I., Elliott, S., Desoucy, E. S., Zakaluzny, S., Sherwood, B. G., Erickson, B. A., ... Myers, J. B. (2019). Optimal timing of delayed excretory phase computed tomography scan for diagnosis of urinary extravasation after high-grade renal trauma. Journal of Trauma and Acute Care Surgery, 86(2), 274-281. https://doi.org/10.1097/TA.0000000000002098