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Lower extremity CT angiograms and their effect on kidney function in orthopedic trauma patients. | LitMetric
Objectives : To evaluate the frequency of unindicated CT Angiograms (CTAs) obtained at our institution and the association between contrast-induced nephropathy (CIN) and decreased glomerular filtration rate (GFR).Design : Retrospective case series SETTING: Academic Level 1 trauma center PATIENTS/PARTICIPANTS: Patients aged 18 years and older with CTAs following lower-extremity (LE) trauma between 2010-2018.Intervention : CTAs performed in 257 LEs and corresponding pre- and post-contrast renal function labs in these LE trauma patients.Main Outcome Measurements : The primary outcome was vascular injury requiring intervention. Secondary outcomes were CIN and the association of CIN with decreased GFR and injury severity score (ISS).Results : There was no indication (no hard signs of vascular injury, ABI>0.9) for CTA in 121 patients (61%) of the total 199 patients. Of the 78 patients with signs of vascular injury or ABI<0.9, 35 (45%) had positive CTAs and 15 (19.2%) required vascular intervention. Of the 121 unindicated patients, 26 (21%) had positive CTAs and 1 (0.008%), a knee dislocation, required vascular intervention. In 155 patients with renal function labs, initial GFR<60ml/min was a risk factor for CIN as compared to GFR>60ml/min (p=0.001). Rate of CIN did not correlate with Injury Severity Score (ISS).Conclusions : CTAs are obtained more often than indicated and initial GFR<60ml/min is a risk factor for developing CIN, irrespective of the trauma burden. CTAs should be reserved for when hard signs of vascular injury or ABI<0.9, especially in those patients with decreased renal function.Level Of Evidence : Level IV.
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