OPTIMAL TIMING OF DELAYED EXCRETORY PHASE CT SCAN FOR DIAGNOSIS OF URINARY EXTRAVASATION AFTER HIGH-GRADE RENAL TRAUMA

Introduction Excretory phase CT scan is used for diagnosis of renal collecting system injuries and accurate grading of high-grade renal trauma (HGRT). 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 HGRT (grades III-V) from 14 Level-1 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 cut-off 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 of 212 patients (22%) were diagnosed with urinary extravasation. Median time between portal venous and excretory phases was 4 minutes (IQR: 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% CI: 1.09-1.22, P

from Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2CGacss