Assessing the impact of guideline non-adherence on the diagnosis of genitourinary injuries in acute trauma settings

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2025-09-24 DOI:10.1016/j.amjsurg.2025.116628

Andrea D. Juneau, Rebecca C. Edwins, Eniola A. Ogundipe, Whitney J. Richardson, Weijing Huang, Leah D. Ashby, Uzoma A. Anele

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引用次数: 0

Abstract

Background

Delayed recognition of genitourinary injuries can cause significant harm in trauma patients. Despite established guidelines, inconsistent adherence may increase this risk.

Methods

We accessed a prospectively-managed Level 1 trauma center database (2020–2023) for patients with urotrauma, assessing American Urological Association Urotrauma Guideline adherence (GA), non-adherence (GNA), and missed injury (MI) rates.

Results

Of 387 patients (411 injuries), GNA occurred in 33.6 % (138/411), with MI in 18.1 % (25/138). Renal injuries predominated but caused fewer MI than ureteral injuries. Most GNA cases involved missing urinalysis or hematuria documentation (45.7 %) or omitting follow-up imaging (20.3 %). Among MI, 72 % required delayed urologic intervention (median 5.5 days post-presentation) compared to GA (p < 0.001) with a readmission rate of 12 % (3/25).

Conclusions

GNA occurred in over one-third of cases; nearly one-fifth progressed to MI, which carried a significantly increased likelihood of delayed surgical intervention and longer time to intervention. Strengthening institutional adherence to urotrauma guidelines could reduce missed injuries and improve outcomes.

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评估指南不遵守对急性创伤情况下泌尿生殖系统损伤诊断的影响。

背景：泌尿生殖系统损伤的延迟识别会对创伤患者造成重大伤害。尽管制定了指导方针，但不一致的坚持可能会增加这种风险。方法：我们访问了一个前瞻性管理的1级创伤中心数据库（2020-2023），用于尿外伤患者，评估美国泌尿学会尿外伤指南的依从性（GA）、不依从性（GNA）和漏伤（MI）率。结果：387例患者（411例）中，GNA发生率为33.6% (138/411)，MI发生率为18.1%（25/138）。肾损伤为主，但引起心肌梗死的发生率低于输尿管损伤。大多数GNA病例包括遗漏尿液分析或血尿文件（45.7%）或遗漏随访影像（20.3%）。在MI患者中，与GA患者相比（p < 0.001）， 72%的患者需要延迟泌尿系统干预（发病后中位5.5天），再入院率为12%（3/25）。结论：超过三分之一的病例发生GNA；近五分之一的患者进展为心肌梗死，这显著增加了延迟手术干预的可能性，并延长了干预时间。加强对泌尿创伤指南的机构遵守可以减少漏诊损伤并改善预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.