Mp18-16 Comparison of Nonoperative and Surgial Management of Renal Trauma; Can We Predict When Nonoperative Management Fails?

Bjurlin, Marc A.; Fantus, Richard J.; Fantus, Richard J; Villines, Dana

doi:10.1016/j.juro.2015.02.1048

Cited by 12 publications

(27 citation statements)

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“…We found a decrease in the rate of nephrectomy in our study period, suggesting adoption of kidney-sparing management across interfacility transfers and tiered trauma systems. Increasing evidence supports nonoperative management, especially for low-grade (I-III) renal injuries [8,[22][23][24][25][26]. Even nonoperative management of the most seriously injured kidneys (grade IV-V) has Fig.…”

Section: Discussionmentioning

confidence: 99%

“…The primary outcome was operative management, categorized as nonoperative management, nephrectomy, or angioembolization. We defined nonoperative management as no renal procedure CPT code within 24 h after admission, similar to prior studies [6][7][8]. The primary comparison of interest was patients transferred to an ACS level I center versus patients who were primarily treated at level II or lower ACS verification (including undesignated), and whether the impact of transfer to a level I center varied by renal injury severity.…”

Section: Variablesmentioning

confidence: 99%

“…Adjusted replaced the past tendency toward aggressive surgical exploration in select, well-staged, and hemodynamically stable cases [8,27,28]. The time trend of renal trauma management has recently been studied, but has not previously been evaluated at the level of tiered trauma systems or interfacility transfer [29].…”

Section: Crudementioning

confidence: 99%

“…Not all trauma centers submitting data to the NTDB use the same AIS version and not all AIS scores correspond to AAST renal grades. However, this method of conversion to AAST renal grade has been employed successfully in prior studies evaluating renal trauma [8,9,37]. The indication for operative management is not recorded in the NTDB; as a result, we cannot comment on which patients had operative management of the renal injury during exploration for other suspected injuries.…”

Section: Limitationsmentioning

confidence: 99%

See 3 more Smart Citations

Impact of Trauma Center Designation and Interfacility Transfer on Renal Trauma Outcomes: Evidence for Universal Management

Bjurlin

Renson

Fantus

et al. 2019

European Urology Focus

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Section: Discussionmentioning

confidence: 99%

Section: Variablesmentioning

confidence: 99%

Section: Crudementioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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Impact of Trauma Center Designation and Interfacility Transfer on Renal Trauma Outcomes: Evidence for Universal Management

Bjurlin

Renson

Fantus

et al. 2019

European Urology Focus

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“…We included blunt trauma patients with traumatic renal injuries, which were identi ed by AIS codes using the method described by Kuan et al 12 AIS codes were converted to AAST renal injury grades, excluding codes that did not match. 15,16,17 We excluded patients who were in cardiac arrest on hospital arrival, and those whose records were missing information on age, sex, vital signs on arrival, ISS, or mortality. We de ned cardiac arrest on hospital arrival as a systolic blood pressure of 0 mmHg or a heart rate of 0 bpm on hospital arrival.…”

Section: Participantsmentioning

confidence: 99%

Trends and outcomes of blunt renal trauma management: A nationwide cohort study in Japan

Nakao

Katayama

Hirayama

et al. 2020

Preprint

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Background There is a paucity of information for predicting patient outcomes other than the American Association for the Surgery of Trauma (AAST) renal injury scale. The aim of this study was to evaluate the association between the patient characteristics and outcomes of patients with blunt renal trauma using a nationwide database in Japan. Methods We performed a retrospective analysis of the Japan Trauma Data Bank (JTDB) from 2004 to 2018. We identified patients with blunt renal trauma by AIS codes converted to AAST grades. We evaluated trends in patient characteristics and management, and assessed factors associated with mortality and nephrectomy using a multivariable logistic regression analysis. Results We identified 3,550 patients with blunt renal trauma. Their median age was 43 years and 74.2% were male. Nephrectomy was performed in 3.8% and the overall mortality rate was 9.5%. We found increasing trends in age and emergency abdominal angiography, and decreasing trends in nephrectomy and mortality over the 15-year period. The following factors were associated with mortality: age ≥ 65 years (adjusted OR 3.36), pedestrian accident (adjusted OR 1.94), fall from height (adjusted OR 1.91), shock on arrival (adjusted OR 4.02), concomitant injuries to head/neck (adjusted OR 3.14), pelvis/lower-extremity (adjusted OR 1.59), liver (adjusted OR 1.68), spleen (adjusted OR 1.45), and gastrointestinal tract (adjusted OR 1.90), AAST grade III-V (adjusted ORs 1.42, 2.16 and 5.55), and emergency abdominal angiography (adjusted OR 0.70). The following factors were associated with nephrectomy: shock on arrival (adjusted OR 1.98), concomitant injuries to thorax (adjusted OR 0.46) and spleen (adjusted OR 2.07), AAST grade III, IV and V (adjusted ORs 18.40, 113.89, and 468.17) and emergency abdominal angiography (adjusted OR 0.28). Conclusions We demonstrated that the AAST grade and emergency angiography were associated with mortality and nephrectomy in blunt renal trauma in the Japanese population. Trial registration: Not applicable

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Case report of bilateral penetrating renal trauma caused by a wooden stick

Xie

Liu²,

Chen³

et al. 2020

Medicine

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Rationale: Kidney is the most frequently injured organ of the genitourinary system during trauma. Bilateral penetrating renal trauma (BPRT) is extremely rare and sporadically reported in the previous literature. Here, we reported a unique case of BPRT.Patient concerns: A 43-year-old man, with no medical history, was accidentally penetrated by a wooden stick and presented with sharp pain in the left flank.Diagnosis: Laboratory tests revealed microscopic hematuria, mildly elevated leucocyte and amylase, normal hemoglobin (145 g/L) and creatinine (1.05 mg/dl). Computed tomography demonstrated bilateral penetrating renal injuries with perinephric/subcapsular hematoma, fracture of the second lumbar vertebra and 10th rib.Interventions: An emergency exploratory laparotomy was executed immediately. According to the American Association for the Surgery of Trauma Organ Injury Scale grading system, grade V and III injuries were considered for the left and right kidney, respectively. Nephrectomy and renorrhaphy were performed on the left and right kidney, respectively.Outcomes: The postoperative course was uneventful. Eleven days after the surgery, the patient discharged with no complications.Lessons: We present a rare and challenging case which was handled successfully, and it may provide useful information for the management of BPRT.

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Mp18-16 Comparison of Nonoperative and Surgial Management of Renal Trauma; Can We Predict When Nonoperative Management Fails?

Cited by 12 publications

References 0 publications

Impact of Trauma Center Designation and Interfacility Transfer on Renal Trauma Outcomes: Evidence for Universal Management

Impact of Trauma Center Designation and Interfacility Transfer on Renal Trauma Outcomes: Evidence for Universal Management

Trends and outcomes of blunt renal trauma management: A nationwide cohort study in Japan

Case report of bilateral penetrating renal trauma caused by a wooden stick

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