Optimal timing of delayed excretory phase computed tomography scan for diagnosis of urinary extravasation after high-grade renal trauma.
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Keihani Sorena, Putbrese Bryn E, Rogers Douglas M, Patel Darshan P, Stoddard Gregory J, Hotaling James M, Nirula Raminder, Luo-Owen Xian, Mukherjee Kaushik, Morris Bradley J, Majercik Sarah, Piotrowski Joshua, Dodgion Christopher M, Schwartz Ian, Elliott Sean P, DeSoucy Erik S, Zakaluzny Scott, Sherwood Brenton G, Erickson Bradley A, Baradaran Nima, Breyer Benjamin N, Fick Cameron N, Smith Brian P, Okafor Barbara U, Askari Reza, Miller Brandi, Santucci Richard A, Carrick Matthew M, Kocik Jurek F, Hewitt Timothy, Burks Frank N, Heilbrun Marta E, Myers Jeremy B, in conjunction with the Trauma and Urologic Reconstruction Network of Surgeons
Аннотация
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.