A National Study of Trauma Level Designation and Renal Trauma Outcomes

Abstract

Purpose We examined the initial management of renal trauma and assessed patterns of management based on hospital trauma level designation. Materials and Methods The National Trauma Data Bank is a comprehensive trauma registry with records from hospitals in the United States and Puerto Rico. Renal injuries treated at a member hospital from 2002 to 2007 were identified. We classified initial management as expectant, minimally invasive (angiography, embolization, ureteral stent or nephrostomy) or open surgical management based on ICD-9 procedure codes. The primary outcome was use of secondary therapies. Results Of 3,247,955 trauma injuries in the National Trauma Data Bank 9,002 were renal injuries (0.3%). High grade injuries demonstrated significantly higher rates of definitive success with the first urological intervention at level I trauma centers vs other trauma centers (minimally invasive 52% vs 26%, p <0.001), and were more likely treated successfully with conservative management (89% vs 82%, p <0.001). When adjusting for other known indices of injury severity, and examining low and high grade injuries, level I trauma centers were 90% more likely to offer an initial trial of conservative management (OR 1.90; 95% CI 1.19, 3.05) and had a 30% lower chance of patients requiring multiple procedures (OR 0.70; 95% CI 0.52, 0.95). Conclusions Following multivariate analysis conservative therapy was more common at level I trauma centers despite the patient population being more severely injured. Initial intervention strategies were also more definitive at level I trauma centers, providing additional support for tiered delivery of trauma care.

Relationship of trauma centre characteristics and patient outcomes: a systematic review

“…Concurrent with evolution of trauma management has been the promotion of tiered delivery of trauma care that focuses on the transfer of more acutely injured patients to high‐level trauma centres (Hotaling et al . ). Trauma centres in the United States are classified into five levels of trauma care, with the most acute being level I and the lowest acuity designated level V by ACS or State.…”

Grade IV renal trauma management. A revision of the AAST renal injury grading scale is mandatory

“…This has allowed more renal injuries to be managed conservatively. Furthermore, super selective angioembolization techniques have been developed to embolize sub-segmental arteries: this has proved to be an effective adjunct in treating active hemorrhages while preserving a modest amount of functioning parenchyma [11,12].…”

Contemporary trends in the immediate surgical management of renal trauma using a national database

“…Given improved dissemination of renal trauma guidelines and advances in minimally invasive treatment such as angioembolization for the treatment of renal trauma, a recent updated analysis of the NTDB revealed that only 8% of patients required a nephrectomy[7, 8]. In the present paper, we present a descriptive analysis of patients who required surgical intervention for renal trauma during the first 24 hours of admission.…”