Resource Utilization and Outcomes in Isolated Low-Grade Renal Trauma at a Level 1 Trauma Center

Abstract

Objective: To examine admission and transfer patterns of isolated low-grade renal trauma given lack of evidenced based guidelines.

Methods: We employed a retrospective cohort design to analyze patients with low grade renal trauma from 2005 to 2018. We used an Abbreviated Injury Score (AIS) <3 for non-abdominal categories to ensure that intensive care unit admission/hospital transfer was due to renal trauma (n = 87). Treatment and discharge survival were compared.

Results: Mean age for floor (n = 31) and intensive care unit (ICU) (n = 46) patients were 33 (IQR = 20) and 42 (IQR = 46) years old, respectively. Mean injury severity score (ISS) was 7.7 (IQR 4) for floor and 8 (IQR=3.75) for ICU admissions (P = .61) Mean ISS was 7.53 (IQR = 4) for transfers and 8.27 (IQR = 3.25) for non-transfers (P = .26). Blood products were administered only to 3 (6.5%) ICU patients all over 60 years old. Fourteen (45.1%) and 26 (56.5%) of floor and ICU admissions were transferred from a lower-level trauma center. ICU mean length of stay (LOS) was 37 hours (IQR = 23 h.). Mean hospital LOS was 43.4 hours and 71.9 hours for the floor and ICU patients (P = .08), and 69.02 hours and 52.58 hours for transfer vs non-transferred (P = .31). All patients were discharged alive and the majority (94%) was discharged home.

Conclusion: Given expedient ICU discharge, low transfusion rate, and low complication rate, inter-hospital transfer and ICU admission are unnecessary for patients under 65 years. Transfer and admission protocols for isolated renal trauma are needed to avoid resource overutilization.