title: Utility of MDCT findings in predicting patient management outcomes in renal trauma.
abstract: OBJECTIVE
  The purpose of this study is to assess the utility of computed tomography (CT) in predicting clinical outcomes in renal trauma.
  
  
  METHODS
  This retrospective study was IRB approved and HIPAA compliant; informed consent was waived. One-hundred-sixty-two, trauma-related renal injuries (157 adults) from January 01, 2006 to December 31, 2013 were included in this retrospective study. CT findings of vascular and collecting system (CS) injuries were recorded, and American Association for the Surgery of Trauma (AAST) renal injury grades were assigned. Fisher's exact test evaluated correlations between AAST grade and active hemorrhage, AAST grade and surgical/endovascular therapy, active hemorrhage and surgical/endovascular therapy, and size of perinephric hematomas and CS injuries. The unpaired t test correlated to the size of perinephric hematomas in CS injuries diagnosed on initial versus repeat imaging.
  
  
  RESULTS
  AAST grades were as follows: 120 grades I-III and 42 grade IV/V. Active hemorrhage was diagnosed in 25 (15%) patients and CS injury in 22 (14%) patients. Seven (8%) patients received surgical/endovascular therapy. There were statistically significant correlations between AAST grade and active hemorrhage (p = 0.003), active hemorrhage and surgical/endovascular therapy (p < 0.0001), and large perinephric hematomas (>2 cm) and CS injuries (p < 0.0001). There was no significant correlation between AAST grade and surgical/endovascular therapy (p = 0.08). Of the CS injuries (50%), 11/22 had no evidence of CS injury on initial imaging, being detected on follow-up CT. These "masked cases" demonstrated significant differences in perinephric hematoma size when compared to CS injuries diagnosed on initial imaging (p = 0.01).
  
  
  CONCLUSIONS
  Active hemorrhage in renal trauma is a significant predictor of surgical/endovascular therapy, in contradistinction to the AAST grade. In collecting system injuries, a large fraction was not detectable on initial CT, supporting the need for repeat imaging in cases with large perinephric hematomas.
authors.affiliation: Department of Radiology, Boston University Medical Center, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA, 02118, USA. Arthur.baghdanian@bmc.org.
authors.forename: Arthur H
authors.initials: AH
authors.lastname: Baghdanian
authors.affiliation: Department of Radiology, Boston University Medical Center, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA, 02118, USA.
authors.forename: Armonde A
authors.initials: AA
authors.lastname: Baghdanian
authors.affiliation: Department of Radiology, Boston University Medical Center, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA, 02118, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Armetta
authors.affiliation: Department of Urology, Professor and Chairman, Boston University Medical Center, Shapiro Center - Suite 3B, 725 Albany St., Boston, MA, 02118, USA.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Babayan
authors.affiliation: Department of Radiology, Boston University Medical Center, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA, 02118, USA.
authors.forename: Christina A
authors.initials: CA
authors.lastname: LeBedis
authors.affiliation: Department of Radiology, Boston University Medical Center, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA, 02118, USA.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Soto
authors.affiliation: Department of Radiology, Boston University Medical Center, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA, 02118, USA.
authors.forename: Stephan W
authors.initials: SW
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007668:Kidney / Q000000981:diagnostic imaging* / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D012189:Retrospective Studies
keywords: Computed tomography; Emergency radiology; Genitourinary system; Kidney; Renal trauma; Trauma