title: What are the specific computed tomography scan criteria that can predict or exclude the need for renal angioembolization after high-grade renal trauma in a conservative management strategy?
abstract: BACKGROUND
  The indications of renal angioembolization for patients with high-grade renal trauma (HGRT) are based on angiographic criteria to reduce the failure rate of conservative management (CM). There is no consensus to predict or exclude an indication of renal angioembolization with a computed tomography (CT) scan. The aim of this study was to evaluate CT-specific criteria to predict or exclude the need for renal embolization.
  
  
  METHODS
  All traumatized patients admitted with renal injury were considered between 2005 and 2009. We included all patients who had an HGRT (classified by American Association for the Surgery of Trauma Organ Injury Scale grade≥3) treated by CM. We collected the demographic, CT, angiographic, management, and outcome data for these patients. CT criteria were retrospectively studied to define their predictive values for renal embolization.
  
  
  RESULTS
  Among 101 patients with renal injury, 58 were HGRT, and 53 of them were treated by CM. Ten patients (19%) received renal embolization because of an ongoing renal hemorrhage. There was no significant difference for urologic interventions (2 [20%] vs. 7 [16%]), CM failure rate (1 [10%] vs. 2 [5%]), and during hospital stay between these patients and those who did not received embolization. None of the CT criteria had a negative predictive value for renal embolization to 100%, only the absence of intravascular contrast extravasation associated with a perirenal hematoma rim distance<25 mm excludes an indication for embolization.
  
  
  CONCLUSIONS
  In patients with HGRT who had bleeding, a strategy of targeted angiography can be realized safely in using specific CT scan criteria that can predict with high accuracy and exclude the need for embolization, without reducing the success rate of CM.
authors: Department of Anesthesiology and Critical Care, Montpellier University Hospital, Department of Radiology, Montpellier I University, Equipe soutenue par la Région et l'Inserm ERI-25, Montpellier, France. j-charbit@chu-montpellier.fr
authors: Jonathan
authors: J
authors: Charbit
authors: Jonathan
authors: J
authors: Manzanera
authors: Ingrid
authors: I
authors: Millet
authors: Jean-Paul
authors: JP
authors: Roustan
authors: Patrick
authors: P
authors: Chardon
authors: Patrice
authors: P
authors: Taourel
authors: Xavier
authors: X
authors: Capdevila