CONCOMITANT BLADDER AND RECTAL INJURIES: RESULTS FROM THE AMERICAN ASSOCIATION FOR THE SURGERY OF TRAUMA (AAST) MULTI-CENTER RECTAL INJURY STUDY GROUP.

MedStar author(s):
Citation: The Journal of Trauma and Acute Care Surgery. 88(2):286-291, 2020 Feb.PMID: 31343599Institution: MedStar Washington Hospital CenterDepartment: Surgery/Trauma SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Injury Severity Score | *Multiple Trauma/su [Surgery] | *Rectum/in [Injuries] | *Urinary Bladder/in [Injuries] | Adult | Colostomy/sn [Statistics & Numerical Data] | Cystostomy/sn [Statistics & Numerical Data] | Female | Hospital Mortality | Humans | Length of Stay/sn [Statistics & Numerical Data] | Male | Middle Aged | Multiple Trauma/di [Diagnosis] | Multiple Trauma/mo [Mortality] | Rectum/su [Surgery] | Treatment Outcome | Urinary Bladder/su [Surgery] | Young AdultYear: 2020Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 2163-0755
Name of journal: The journal of trauma and acute care surgeryAbstract: BACKGROUND: Combined traumatic injuries to the rectum and bladder are rare. We hypothesized that the combination of bladder and rectal injures would have worse outcomes than rectal injury alone.CONCLUSION: For patients with traumatic rectal injury, a concomitant bladder injury does not increase the rates of abdominal complications, mortality, or length of stay. Furthermore, the addition of a diverting colostomy for management of traumatic bladder and rectal injury does not change outcomes.LEVEL OF EVIDENCE: IV; prognostic.METHODS: This is an American Association for the Surgery of Trauma multi-institutional retrospective study from 2004-2015 traumatic rectal injury patients who were admitted to one of 22 participating centers. Demographics, mechanism, and management of rectal injury were collected. Patients who sustained a rectal injury alone were compared to patients who sustained a combined injury to the bladder and rectum. Multivariable logistic regression was used to determine if abdominal complications, mortality, and length of stay were impacted by a concomitant bladder injury after adjusting for cofounders.RESULTS: There were 424 patients who sustained a traumatic rectal injury, of which 117 (28%) had a combined injury to the bladder. When comparing the patients with a combined bladder/rectal injury to the rectal alone group there was no difference in admission demographics admission physiology, or injury severity score. There was also no differences in management of the rectal injury and no difference in abdominal complications (13% vs. 16%, p=0.38), mortality (3% vs. 2%, p=0.68), or length of stay (17 days vs. 21 days, p=0.10). When looking at only the 117 patients with a combined injury, the addition of a colostomy did not significantly decrease the rate of abdominal complications (14% vs. 8%, p=0.42), mortality (3% vs. 0%, p=0.99), or length of stay (17 days vs. 17 days, p=0.94). After adjusting for cofounders (AAST rectal injury grade, gender, damage control surgery, diverting colostomy, and length of stay) the presence of a bladder injury did not impact outcomes.All authors: AAST Contemporary Management of Rectal Injuries Study Group, Brown CVR, Bruns B, Bui E, Burlew CC, Holcomb JB, Hopper HA, Musonza T, Osterberg EC, Sava J, Schellenberg M, Sharpe JP, Truitt M, Van Horn J, Veith JOriginally published: The Journal of Trauma and Acute Care Surgery. 2019 Jul 22Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2019-08-23
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 31343599 Available 31343599

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

BACKGROUND: Combined traumatic injuries to the rectum and bladder are rare. We hypothesized that the combination of bladder and rectal injures would have worse outcomes than rectal injury alone.

CONCLUSION: For patients with traumatic rectal injury, a concomitant bladder injury does not increase the rates of abdominal complications, mortality, or length of stay. Furthermore, the addition of a diverting colostomy for management of traumatic bladder and rectal injury does not change outcomes.

LEVEL OF EVIDENCE: IV; prognostic.

METHODS: This is an American Association for the Surgery of Trauma multi-institutional retrospective study from 2004-2015 traumatic rectal injury patients who were admitted to one of 22 participating centers. Demographics, mechanism, and management of rectal injury were collected. Patients who sustained a rectal injury alone were compared to patients who sustained a combined injury to the bladder and rectum. Multivariable logistic regression was used to determine if abdominal complications, mortality, and length of stay were impacted by a concomitant bladder injury after adjusting for cofounders.

RESULTS: There were 424 patients who sustained a traumatic rectal injury, of which 117 (28%) had a combined injury to the bladder. When comparing the patients with a combined bladder/rectal injury to the rectal alone group there was no difference in admission demographics admission physiology, or injury severity score. There was also no differences in management of the rectal injury and no difference in abdominal complications (13% vs. 16%, p=0.38), mortality (3% vs. 2%, p=0.68), or length of stay (17 days vs. 21 days, p=0.10). When looking at only the 117 patients with a combined injury, the addition of a colostomy did not significantly decrease the rate of abdominal complications (14% vs. 8%, p=0.42), mortality (3% vs. 0%, p=0.99), or length of stay (17 days vs. 17 days, p=0.94). After adjusting for cofounders (AAST rectal injury grade, gender, damage control surgery, diverting colostomy, and length of stay) the presence of a bladder injury did not impact outcomes.

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