MP25-18 IMAGING FINDINGS ASSOCIATED WITH RENAL BLEEDING INTERVENTIONS AFTER HIGH-GRADE RENAL TRAUMA: RESULTS FROM THE AMERICAN ASSOCIATION FOR SURGERY OF TRAUMA (AAST) GENITO-URINARY TRAUMA STUDY

Abstract

INTRODUCTION AND OBJECTIVES: In high-grade renal trauma (HGRT), radiologic findings including hematoma rim distance (HRD), laceration location, and intravascular contrast extravasation (ICE) are proposed to be associated with interventions for renal hemorrhage. We aimed to assess the association of multiple imaging findings with renal bleeding interventions in a prospective multi-institutional study of HGRT. METHOD(S): The GU Trauma Study is a multi-center prospective study including data on HGRT from 13 Level-1 trauma centers from 2014-2017. Patients with CT scans at presentation were included. 2 radiologists, blinded to outcomes, reviewed the scans for ICE, laceration location (lateral, medial, complex [lateral and medial]), HRD (largest measure from the edge of the kidney to the hematoma), and hematoma extension (subcapsular, peri-renal, para-renal [beyond the aorta on the left or IVC on the right or into the pelvis]). Renal bleeding interventions included: angioembolization, surgical packing, renorrhaphy, partial nephrectomy, and nephrectomy. Logistic regression established associations between imaging findings and bleeding interventions. RESULT(S): 310 patients met the inclusion criteria. 80% had blunt trauma. Mean age and ISS were 35.0+/-16.3 and 25.3+/-12.7. Injuries were AAST grades III, IV, and V in 60%, 32%, and 8%. Overall, 46 (15%) underwent bleeding interventions including: renal angioembolization (18), nephrectomy (17), and other surgical procedures (11). 68 (22%) had ICE. laceration location was lateral (93; 31%), medial (69; 23%), or complex (134; 45%). Hematoma extension was subcapsular (8; 3%), peri-renal (201; 72%), and para-renal (70; 25%). Mean HRD in all patients was 2.2+/-0.2 cm and was higher in patients who underwent bleeding interventions (4.3+/-0.3 vs. 1.8+/-0.2 cm). In the bleeding intervention group 54% had HRD>3.5 cm compared to 14% in the conservative group. In univariate analysis, ICE, complex laceration, pararenal hematoma, and PRD>3.5 cm were associated with bleeding intervention (Table-1). CONCLUSION(S): Several radiologic factors are associated with renal bleeding interventions. These factors could be used to create a bleeding risk nomogram guiding clinical decision making for patients with HGRT.