Document Detail


Process improvement in trauma: traumatic bladder injuries and compliance with recommended imaging evaluation.
MedLine Citation:
PMID:  23147187     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We hypothesized that our compliance was low with recommended imaging for evaluation of traumatic bladder injury, which includes either a computed tomographic (CT) cystogram or plain cystogram. We sought to determine if poor compliance impacted diagnosis, management, and outcome of patients with bladder injury.
METHODS: Patients with bladder injury were identified from all Level 1 hospital trauma registries in Utah from 1996 to 2010. Details including presentation, management, and outcome of bladder injury were described using descriptive statistics and bivariate and logistic regression analysis.
RESULTS: A total of 124 patients were identified from the trauma registries with bladder injury and adequate records for review. The mean age was 35 years. Blunt trauma occurred in 110 patients (88%). Mean Injury Severity Score was 26.3. The leading concomitant injury was pelvic fracture in 98 patients (79%). Bladder injury was extraperitoneal in 75 patients (60%), intraperitoneal in 39 (31%), and both or undetermined in 10 (8%). A higher risk of death was seen in intraperitoneal with or without concomitant extraperitoneal injury compared with extraperitoneal injury only (odds ratio, 12.4; 95% confidence interval, 2.37-99.2). Management was operative in 68 (55%) patients (95% intraperitoneal, 31% extraperitoneal). Of the 124 injuries, 100 were detected with imaging: standard CT scan in 70 (56%) and cystogram or CT cystogram in 30 (24%). The remaining injuries were discovered operatively or were undocumented (n = 24, 19%). Initial imaging missed or incorrectly diagnosed bladder injury in 13 (13%) patients (nine from standard CT scan and four from CT or plain cystogram). In five cases diagnosed by standard CT scan, extraperitoneal injuries were misdiagnosed as intraperitoneal and operatively explored.
CONCLUSION: There was poor compliance with imaging recommendations for evaluation of suspected bladder injury by either CT cystogram or plain cystogram at Level 1 trauma centers in Utah. We have implemented a genitourinary trauma imaging algorithm designed to minimize errors in bladder injury diagnosis.
LEVEL OF EVIDENCE: Therapeutic study, level IV.
Authors:
Jeremy B Myers; Michael B Taylor; William O Brant; William Lowrance; M Chad Wallis; Angela P Presson; Stephen E Morris; Raminder Nirula; Mark H Stevens
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  74     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-28     Completed Date:  2013-03-21     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  264-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Division of Urology and the Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, Utah 84132, USA. jeremy.myers@hsc.utah.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Child
Female
Guideline Adherence*
Humans
Injury Severity Score
Male
Practice Guidelines as Topic*
Quality Improvement*
Tomography, X-Ray Computed*
Trauma Centers
Urinary Bladder / injuries*,  radiography*
Wounds, Nonpenetrating / radiography

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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