Management of blunt force bladder injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma

Background The diagnostic evaluation and clinical management of bladder injuries due to blunt force trauma is variable. We aim to formulate a practice management guideline using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Methods The working group, PICO (Patient, Intervention, Comparator, Outcome), formulated four questions regarding the following topics: 1) diagnostic evaluation based on patient baseline risk of bladder injury (CT cystography vs. no imaging); 2) management of intraperitoneal bladder injuries (operative versus non-operative); 3) management of extraperitoneal bladder injuries based on complexity of injury (operative vs. non-operative); and 4) diagnostic follow-up of bladder injuries based on complexity of repair (cystography versus no cystography). A systematic review of the MEDLINE database for English language articles with adult patients was undertaken. RevMan 5 (Cochran Collaboration) and GRADEpro (Grade Working Group) software were utilized. Recommendations were voted on by working group members. Consensus was obtained for each recommendation. Results Three hundred and ninety-three articles were screened, resulting in a full-text review of 64 articles. Seventeen articles were used to formulate the recommendations of this guideline. Several recommendations are made. The need for initial CT cystography after trauma depends on characteristics of the trauma itself, but it is not recommended in patients without gross hematuria. In general, patients with intraperitoneal bladder ruptures should undergo operative repair. This is not routinely necessary in those with extraperitoneal ruptures unless the injury is complex. The need for follow-up cystography after bladder repair depends on the risk of urine leak. Those with low risk of urine leak do not require a follow-up study. Conclusion Using the GRADE process, the panel made nine recommendations based on 4 PICO questions concerning the evaluation and management of blunt force bladder injuries. Level of evidence Level III meta-analysis Study type: Practice management guideline Corresponding Author: Lawrence L Yeung, 1600 SW Archer Rd, Box 100247, Gainesville, FL 32610. Phone: 352-273-8239. Fax: 352-273-7515. Email: lawrence.yeung@urology.ufl.edu This work was presented in part at the 27th annual meeting of the Eastern Association for the Surgery of Trauma, January 14–18, 2014, in Naples, Florida, and at the 31st annual meeting of the Eastern Association for the Surgery of Trauma, January 9-13, 2018, in Orlando, FL. Conflict of Interest: The authors declare no conflict of interest. Disclosures of Funding: No funding received © 2018 Lippincott Williams & Wilkins, Inc.

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