M. Polcz2, C. Orbay2, V. Polcz1, L. Podolsky2, M. Bukur1, I. Puente1, C. Prays2, F. Habib1 1Broward Health Medical Center,Trauma,Ft Lauderdale, FL, USA 2Florida International University,Surgery,Miami, FL, USA
Introduction:
Existing studies do not demonstrate an increased incidence of AKI in trauma patients after computed tomography (CT) with IV contrast. In a subset of patients, however, the contrast load is compounded by the need for angiography. The incidence and consequences of AKI in this cohort are unknown, and form the objective of this study.
Methods:
Records of patients treated at our urban Level I trauma center over a 7-year period (2007-2013) who received both CT with IV contrast and angiography as part of their trauma workup were reviewed. Deaths within the first 24 hours of arrival were excluded. AKI was defined as an increase in serum creatinine of ≥0.3 mg/dL or ≥50% over baseline. Creatinine values were recorded in-between studies as well as 24 and 48 hours after the second study. Univariate analysis was performed using the Student's t test, chi square test and Fisher's Exact test as appropriate. Logistic regression was performed. A p value of < 0.05 was deemed significant.
Results:
Of 119 patients included, criteria for AKI were met in 29 (25.4%). These patients were more likely male (p=0.01), older (p=0.02), more severely injured (p=0.049) and have higher baseline creatinine values (p=0.01). Race, mechanism of injury, hypotension on arrival, Charlson Comorbidity Index, and order of study performance were not significant (all p>0.05). Patients who developed AKI were more likely to die (p=0.02), have need for dialysis (p=0.001), and have increased lengths of ICU (p=0.002) and hospital stay (p=0.001). On logistic regression, age and receiving an angiogram first were predictive.
Conclusion:Exposure to multiple contrast loads results in a high incidence of AKI among trauma patients and is associated with higher mortality, the need for dialysis, and longer ICU and hospital stays. Further prospective studies are clearly warranted
