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Repeat CT in Isolated Intra-abdominal Renal Trauma is Not Associated with Reduced Complications, Readmissions, or Delayed Interventions
Viktor Xavier Flores, MD1, Benjamin Abelson, MD1, Shilin Zhao, PhD1, George Koch, MD1, Caroline B. Khanna, BA1, Harold Lovvorn, MD1, Amber L. Greeno, MSN, APRN1, Kelly Collins, BS1, Ching Man Carmen Tong, DO2, David M. Kitchens, MD2, Vinaya P. Bhatia, MD3, Jonathan Gerber, MD3, Christopher Long, MD4, Dana Weiss, MD4, Gabrielle Crane, MD1, Jacob Lucas, DO5, Albert S. Lee, DO6, Christina Ho, MD6, Jeffrey Ellis, MD5, Xiaoyi Zhuo, MD3, Ming-Hsien Wang, MD3, Douglass Clayton, MD1.
1Vanderbilt University Medical Center, Nashville, TN, USA, 2Children's of Alabama, Birmingham, AL, USA, 3Texas Children's Hospital at Baylor College of Medicine, Houston, TX, USA, 4Children's Hospital of Philadelphia, Philadelphia, PA, USA, 5Einstein Healthcare Network, Philadelphia, PA, USA, 6Children's National Medical Center, Washington DC, DC, USA.

BACKGROUND:The 2020 AUA Urotrauma guidelines recommend repeat computerized tomography (CT) in patients with high grade renal laceration (Grade IV or V) within 48-72hrs of injury. Little is known about the benefits of repeat CT imaging in pediatric patients with isolated renal trauma. We sought to determine if repeating a CT scan for the purposes of evaluating the evolution of a high-grade renal injury impacted inpatient complications, 90-day readmissions, or delayed intervention after discharge. We hypothesize that a repeat CT scan would identify concerns resulting in reduced complications, 90-day readmissions and delayed interventions.
METHODS:Using the multi-institutional Traumatic Renal Injury Collaborative in Kids (TRICKs) consortium database, we retrospectively reviewed all Grade IV and V renal traumas from 5 pediatric centers between 2007 to 2022. Inclusion criteria included patients less than 18 years of age with blunt injuries. Exclusion criteria included having concomitant bowel, hepatic, or splenic injury, or requiring an initial intervention (surgical or radiologic) after the first CT scan. We compared patients with repeat CT scan versus those without repeat CT imaging. The primary outcomes of interest were the incidence of inpatient complications (fever, ileus, uncontrolled pain, intractable nausea/vomiting, acute blood loss anemia, UTI, or Hypotension), 90-day readmissions, and need for delayed intervention after discharge (surgical or interventional radiology).
RESULTS:465 patients were included in the database but after applying criteria, only 84 patients were eligible. Twenty patients had repeat imaging to assess the evolution of their renal injury (Group 1) and 64 patients did not have repeat CT imaging (Group 2). Of the 64 patients in Group 2, 23.4% had a renal ultrasound instead. Demographic, injury, and radiographic details are summarized in Table 1. Patients with repeat CT imaging were less likely to be African Americans (10% vs. 34%, p=0.04), and more likely to have had gross hematuria (85% vs. 49%, p=0.023), evidence of vascular injury (42% vs. 12%, p =0.014), and Grade V injury (35% vs. 9%, p<0.005). After repeating the CT scan, 20% of patients in Group 1 had an intervention versus 33% of the patients in Group 2 with renal ultrasound (p=0.372) (table 2). There were no significant differences between Group 1 and Group 2 in complications (5% vs. 14%, p=0.275), 90-day readmissions (5% vs. 13%, 0.33), or delayed intervention after initial discharge (0% vs. 7.8%, p=0.236).
CONCLUSIONS:
Repeat CT imaging in patients with isolated renal trauma was not associated with reduced inpatient complications, 90-day readmissions, or delayed interventions. To our surprise, follow up renal ultrasound was equally likely to be associated with intervention.
Table 1: Demographic, Initial Injury and Radiographic Factors between Group 1 and Group 2.

Table 2: Intervention after Repeat CT in Group 1 vs. Subset of Patients in Group 2 with Repeat Renal Ultrasound.


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