Management of severe blunt renal trauma in adult patients: a 10‐year retrospective review from an emergency hospital

Jang

Journal of Trauma and Injury

2017

Purpose: Blunt injury accounts for 80-95% of renal injury trauma in the United States. The majority of blunt renal injuries are low grade and 80-85% of these injuries can be managed conservatively. However, there is a debate on the management of patients with high-grade renal injury. We reviewed our experience of renal trauma at our trauma center to assess management strategy for high-grade blunt renal injury. Methods: We reviewed blunt renal injury cases admitted at a single trauma center between August 2007 and December 2015. Computed tomography (CT) scan was used to diagnose renal injuries and high-grade (according to the American Association for the Surgery of Trauma [AAST] organ injury scale III-V) renal injury patients were included in the analysis. Results: During the eight-year study period, there were 62 AAST grade III-V patients. 5 cases underwent nephrectomy and 57 underwent non-operative management (NOM). There was no difference in outcome between the operative group and the NOM group. In the NOM group, 24 cases underwent angioembolization with a 91% success rate. The Incidence of urological complications correlated with increasing grade. Conclusions: Conservative management of high-grade blunt renal injury was considered preferable to operative management, with an increased renal salvage rate. However, high-grade injuries have higher complication rates, and therefore, close observation is recommended after conservative management.

Section: Discussionmentioning

confidence: 99%

Management of High-grade Blunt Renal Trauma

Jang

Journal of Trauma and Injury

2017

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

“…This is an observational prospective study conducted in Hospital João XXIII, a Trauma Center situated in Belo Horizonte, Brazil, which estimated population is 5,7 million people. From January to December 2013, there were 27 patients with blunt renal trauma admitted in Hospital João XXIII who met the criteria for NOM.…”

Section: Methodsmentioning

confidence: 99%

“…4,5 Nowadays, NOM is the standard of care for stable patients with blunt renal trauma. 1,3,4,6,7 Besides having high success rate, it has lower costs and lower hospital length of stay (LOS) if compared to surgical approach.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Nonoperative Management of Blunt Renal Trauma

Azevedo¹,

Souza²,

Starling³

et al. 2015

Objective: To analyze patients with blunt renal trauma who were managed conservatively, with emphasis on clinical presentation, grade of injury, complication and failure rates. Materials and methods:A prospective observational study was conducted in Hospital João XXIII, between January and December 2013. Patients with blunt renal trauma and nonoperative management (NOM) were analyzed during this period. Data were collected in respect to: age, gender, mechanism of trauma, grade of injury, clinical presentation, revised trauma score (RTS), associated abdominal injuries, length of hospital stay and failure, complication and mortality rates.Results: During this period, 27 patients with blunt renal trauma were suitable for nonoperative approach. The most common mechanisms of trauma were motor vehicle accidents (59.2%) and falls (22.2%) and the mean length of hospital stay was 10.5 days. The majority of the patients had grade II (48.1%) and III (29.6%) injuries, with mean RTS of 6.93. The complication rate was 3.7% and the mortality rate was 7.4%. All deaths were related to associated injuries. One patient with grade II injury required nephrectomy. This patient had concurrent injuries. Conclusion:Blunt renal trauma can be successfully managed conservatively, with low complication rates. Nonoperative management is safe in stable patients and in environments with appropriated protocol for this approach.

“…Despite an absent standardized protocol to determine when to intervene in the setting of active renal bleeding, whenever the patient is stable enough to undergo imaging, a helical computerized tomography (CT) scan is the best option to stage the trauma 1 .…”

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

Atualização da classificação e tratamento das lesões renais complexas

Reis

Kim

Moore

et al. 2013

Rev. Col. Bras. Cir.

The "Evidence-based Telemedicine -Trauma & Acute Care Surgery" (EBT-TACS) Journal Club performed a critical review of the literature and selected three up-to-date articles on the management of renal trauma. Our focus was on high-grade renal injuries, defined as AAST injury grades III-V. The first paper was the propose substratification of the AAST grade IV renal injury into grades IVa (Low Risk) and IVb (High Risk). The second paper was a revision of the current AAST renal injury grading system, expanding to include segmental vascular injuries and ureteral pelvic injuries and to establish a more rigorous definition of severe grade IV and V renal injuries. The last article analyses the diagnostic angiography and angioembolization in the acute management of renal trauma using a national data set in the USA. The EBT-TACS Journal Club elaborated conclusions and recommendations for the management of high-grade renal trauma.