title: A national study of trauma level designation and renal trauma outcomes.
abstract: OBJECTIVE
  We examined the initial management of renal trauma and assessed patterns of management based on hospital trauma level designation.
  
  
  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.
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Hotaling
authors.forename: Jin
authors.initials: J
authors.lastname: Wang
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Sorensen
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
authors.forename: John L
authors.initials: JL
authors.lastname: Gore
authors.forename: Jerry
authors.initials: J
authors.lastname: Jurkovich
authors.forename: Christopher D
authors.initials: CD
authors.lastname: McClung
authors.forename: Hunter
authors.initials: H
authors.lastname: Wessells
authors.forename: Bryan B
authors.initials: BB
authors.lastname: Voelzke
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007668:Kidney / Q000293:injuries*; D008297:Male; D010346:Patient Care Management / Q000145:classification*; D012042:Registries; D014481:United States