Is contrast exposure safe among the highest risk trauma patients?

Kim, Dennis Y.; Kobayashi, Leslie; Costantini, Todd W.; Chang, David C.; Fortlage, Dale; Curry, Terry; Wynn, Susan; Doucet, Jay; Bansal, Vishal; Coimbra, Raúl

doi:10.1097/ta.0b013e31823f36e0

Cited by 30 publications

(25 citation statements)

References 23 publications

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“…The results are also supported by some studies in trauma populations that failed to identify contrast dosage as a predisposing factor for CIN 810 13 14 16 17 19 25 Accordingly, it appears that the risk of intravenous contrast-induced nephrotoxicity may not really be as great as we have come to believe 11…”

Section: Discussionsupporting

confidence: 52%

“…To evaluate the possible association between the risk factor and CIN, all patients were further divided into subgroups according to different clinical conditions or comorbidities for comparison between patients with and without angiography. These factors include comorbidities (diabetes, hypertension, cirrhosis), old age (≥55 years),3 16 17 sex, obesity (BMI≥30),25 habitual smoking or alcohol consumption, pre-existing renal insufficiency (initial SCr>1.5 mg/dL or initial eGFR<60 mL/min),8 10 18 shock on arrival (SBP<90 mm Hg),8 10 14 17 anaemia with massive bleeding (initial Hb<11 g/dL),26 need for transfusion (24-hour Hb<10 g/dL),27 significant haemoperitoneum on CT4 severe injury (ISS≥16, SIS 4, 5) 4 ,. 10 , 20 , 27 The Hb level of 11 g/dL or 24-hour Hb of 10 g/dL was adopted in this study according to reported evidence that these have been deemed as a cut-off point for initiating the massive blood transfusion protocol, and guiding the need for blood transfusions to prevent trauma-induced coagulopathy, respectively 26…”

Section: Methodsmentioning

confidence: 99%

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Does angiography increase the risk of impairment in renal function during non-operative management of patients with blunt splenic injuries? A cross-sectional study in southern Taiwan

et al. 2016

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ObjectivesThe aim of the present study was to assess whether angiography after contrast-enhanced CT (CECT) as per the policy of non-operative management would add to the risk of acute kidney injury in patients with blunt splenic injuries (BSIs).DesignCross-sectional study.SettingTaiwan.ParticipantsPatients with BSI aged >16 years, admitted to a level I trauma centre during the period of January 2004 to December 2014, were retrospectively reviewed. A total of 326 patients with BSI with CECT were included in the study, of whom 100 underwent subsequent angiography and 226 did not.Main outcome measuresIncidence of contrast-induced nephropathy (CIN) and renal function as measured by the 48-hour serum creatinine (SCr) levels.ResultsNo significant difference between the patients who underwent angiography and those who did not in terms of the initial haemoglobin (Hb), SCr or estimated glomerular filtration rate (eGFR) level on arrival at the emergency department, 48 hours later, or at discharge. No significant difference in the incidence of CIN was found between these two groups of patients regardless of the criteria for identifying CIN. In the group of patients aged ≥55 years, those who underwent angiography had a significantly worse 48-hour SCr level than those who did not undergo the treatment. In addition, there was no significant difference in the 48-hour SCr level between the two groups of patients when subgrouping the patients according to sex, large haemoperitoneum revealed on CT, systolic blood pressure, initial Hb, initial SCr and initial eGFR levels.ConclusionsThis study demonstrated that angiography does not increase the incidence of CIN, and was not a risk factor to renal function impairment in patients with BSI who had undergone CECT.

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Section: Discussionsupporting

confidence: 52%

Section: Methodsmentioning

confidence: 99%

Does angiography increase the risk of impairment in renal function during non-operative management of patients with blunt splenic injuries? A cross-sectional study in southern Taiwan

et al. 2016

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“…In most studies, diabetes remains an independent risk factor for the development of CIN, (17,25) although diabetes was not a risk factor in our study. That our patients were substantially younger and healthier than most hospital and intensive care unit patients may be a contributing factor.…”

Section: Discussioncontrasting

confidence: 42%

“…(17)(18)(19)(20)(22)(23)(24)(25)(26)(27) However, none of these studies agree about risk factors completely.…”

Section: Discussionmentioning

confidence: 92%

The Risk Factors for Developing Contrast-induced Nephropathy after the Evaluation of Trauma Patients at a Regional Trauma Center in Korea

Park

Kim

et al. 2016

Journal of Trauma and Injury

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Purpose:Computed tomography (CT) with intravenous (IV) contrast is an important step in the evaluation of trauma patients; however, the risk factors for contrast-induced nephropathy (CIN) in these patients remain unclear. This study determined the rate of CIN in trauma patients at a regional trauma center in Korea and identified the risk factors for developing CIN.Methods: We retrospectively reviewed the medical records of 138 patients for the patient demographics, creatinine levels, and vital signs. CIN was defined as an increase in creatinine by 0.5 mg/dL from admission after undergoing CT with IV contrast.Results: Of the patients, 7.2% developed CIN during their admission after receiving IV contrast for CT. In the multivariate analysis, only the creatinine level at presentation (Adjusted odds ratio [aOR], 5.944; 95% confidence interval [CI], 1.486-23.733; p=0.012) and an injury severity score (ISS) greater than 22 (aOR, 1.096; 95% CI, 1.021-1.176; p=0.011) were independently associated with the risk of CIN.Conclusion: CIN is uncommon in trauma patients following CT with IV contrast. The creatinine level at presentation and ISS were independent risk factors for developing CIN in trauma patients. [ J Trauma Inj 2016; 29: 124-128 ]

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“…32 Tais fatores de risco foram obtidos por meio da análise de pacientes em regime de internação hospitalar por razões clínicas. Estudos que focam na população politraumaizada concluem que idade acima de 65 anos, história de diabetes mellitus, creatinina inicial acima de 1,5 mg/ dL, Injury Severity Score acima ou igual a 16 ou 25, segundo outros autores, 33 e hipotensão sistólica inicial (PAS < 90) são os principais fatores determinantes de desenvolvimento de NC. 34 A nefropatia por contraste é marcada pelo seu caráter autolimitado, porém, no contexto do cuidado ao paciente crítico é um fator contribuitório para lesão renal.…”

Section: Nefropatia Por Contraste Iodadounclassified

Acute Renal Injury in polytrauma patients

Romano¹,

Tierno²

2013

Jornal Brasileiro De Nefrologia

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A Injúria Renal Aguda (IRA) no contexto do paciente politraumatizado ocorre, na maioria das vezes, por uma conjuntura de fatores que passam por eventos correlacionados à ressuscitação volêmica inicial, ao grau de resposta inflamatória sistêmica associada ao trauma, ao uso de contraste iodado para procedimentos diagnósticos, à rabdomiólise e à síndro-me compartimental abdominal. Atualmente, passamos por uma fase de uniformização dos critérios diagnósticos da IRA com o Acute Kidney Injury Network (AKIN), sendo a referência mais aceita. Consequentemente, o estudo da IRA no politraumatismo também passa por uma fase de reformulação. Esta revisão da literatura médica visa trazer dados epidemiológicos, fisiológicos e de implicação clínica para o manuseio destes pacientes, bem como expor os riscos do uso indiscriminado de expansores volêmicos e particularidades sobre a instituição de terapia renal substitutiva em indivíduos sob risco de hipertensão intracraniana. IntroduçãoA injúria renal aguda (IRA) no contexto do cuidado ao paciente crítico é sabidamente relacionada a maior tempo de internação hospitalar e a maior mortalidade, 1,2 quanto a sua importância na assistência ao indivíduo politraumatizado. Dados de literatura médica apontam para a mesma direção.Em estudo observacional com cerca de 430 pacientes vítimas de politrauma, Gomes et al.3 demonstraram que 50% deles apresentavam IRA e que aqueles com maiores comprometimentos de função renal permaneciam mais tempo Acute Kidney Injury (AKI) in trauma is, in most cases, multifactorial. Factors related to the initial ressuscitation protocol, degree of the systemic inflamatory response to trauma, contrast nephropathy in diagnostic procedures, rhabdomyolysis and abdominal compartment syndrome are some of those factors. Nowadays a uniformization in diagnostic criteria for AKI has been proposed by the Acute Kidney Injury Network (AKIN) and as a result the incidence of AKI and its impact in outcomes in trauma patients also needs to be reconsider. In this review we aim to approach epidemiologic, physiologic and clinical relevant data in the critical care of patients victims of trauma and also to expose the risks of indiscriminate use of volume expanders and the interaction between renal replacement theraphy and intracranial hypertension. Injúria Renal Aguda no paciente politraumatizadoAcute Renal Injury in polytrauma patients resumo Palavras-chave: diálise renal, rabdomiólise, renal aguda, traumatismo múltiplo. AbstrActKeywords: acute kidney injury, multiple trauma, renal dialysis, rhabdomyolysis.

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Is contrast exposure safe among the highest risk trauma patients?

Abstract: A complete trauma workup including studies requiring IV contrast exposure should be considered safe even among high-risk trauma patients.

Cited by 30 publications

References 23 publications

Does angiography increase the risk of impairment in renal function during non-operative management of patients with blunt splenic injuries? A cross-sectional study in southern Taiwan

Does angiography increase the risk of impairment in renal function during non-operative management of patients with blunt splenic injuries? A cross-sectional study in southern Taiwan

The Risk Factors for Developing Contrast-induced Nephropathy after the Evaluation of Trauma Patients at a Regional Trauma Center in Korea

Acute Renal Injury in polytrauma patients

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