K. Matsushima1, J. Cho1, M. Luttio1, A. Strumwasser1, K. Inaba1, D. Demetriades1 1University Of Southern California,Los Angeles, CA, USA
Introduction: Contrast-enhanced computed tomography (CECT) has become the mainstay of diagnostic work up in patients following blunt trauma. Although the overall incidence of acute kidney injury (AKI) in trauma patients has been reported to be as high as 30%, the actual risk of iodinated intravenous (IV) contrast for developing AKI has been questioned with the increasing use of low- or iso-osmolar IV contrast agents. We hypothesized that the incidence of AKI would be extremely low in mildly injured patients who received CECT for trauma work-up.
Methods: A prospectively collected institutional blunt trauma database was reviewed from 11/2014 to 5/2015. We included mildly injured patients (AIS<2 in all body regions) who had at least two creatinine level measured during their hospital stay. The incidence of AKI, defined by the Acute Kidney Injury Network criteria, in patients who received CECT (contrast group) was compared with that in patients without CECT as part of their trauma work-up (no-contrast group). A multivariate logistic regression analysis was performed to examine the impact of IV contrast use on the incidence of AKI.
Results: A total of 276 patients met our inclusion criteria. Median age: 35 years, male gender: 62.7%. Median length of hospital stay: 2 days. 247 patients (89.5%) underwent CECT for their initial trauma work-up. Median IV contrast volume was 100ml. A total of 5 patients developed AKI. The incidence of AKI in the contrast group and the no-contrast group was 1.6% and 3.4%, respectively (p=0.43). Each of these 5 patients developed stage 1 AKI and none required a prolonged hospital stay for the management of AKI. After adjusting for clinically significant covariates in a logistic regression model, the administration of IV contrast was not significantly associated with the incidence of AKI (OR: 0.40, 95% CI: 0.04-3.96, p=0.44).
Conclusion: The current study showed the extremely low incidence of AKI in patients with minor injury and, specifically, the minimal impact of IV contrast on the incidence of AKI.