A national study of trauma level designation and renal trauma outcomes

James M. Hotaling, Jin Wang, Mathew D. Sorensen, Frederick P. Rivara, John L. Gore, Gregory Jurkovich, Christopher D. McClung, Hunter Wessells, Bryan B. Voelzke

Research output: Contribution to journalArticlepeer-review

34 Scopus citations

Abstract

We examined the initial management of renal trauma and assessed patterns of management based on hospital trauma level designation. 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. 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). 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.

Original languageEnglish (US)
Pages (from-to)536-541
Number of pages6
JournalJournal of Urology
Volume187
Issue number2
DOIs
StatePublished - Feb 1 2012
Externally publishedYes

Keywords

  • health facilities
  • kidney
  • outcome assessment (health care)
  • wounds and injuries

ASJC Scopus subject areas

  • Urology

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