Successful Nonoperative Management of the Most Severe Blunt Renal Injuries

Wilden, Gwendolyn M. van der; Velmahos, George C.; Joseph, D’Andrea; Jacobs, Lenworth M.; DeBusk, M. George; Adams, Charles A.; Gross, R; Burkott, Barbara; Agarwal, Suresh; Maung, Adrian A.; Johnson, Dirk C.; Gates, Jonathan D.; Kelly, Edward; Michaud, Yvonne; Charash, William E.; Winchell, Robert J.; Desjardins, Steven; Rosenblatt, Michael S.; Gupta, Sanjay; Gaeta, Miguel; Chang, Yuchiao; Moya, Marc A. de

doi:10.1001/jamasurg.2013.2747

Cited by 108 publications

(46 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, result of the repeat angioembolization were quite dramatic, with an overall success rate of 92%. Similar results of low success rates in initial angioembolization were observed in studies by Van der Wilden et al[30] and Menaker et al[31], highlighting the importance of carefully scrutinizing such patients for signs of recurrent hemorrhage. There are limited reports of thrombolysis in posttraumatic renal artery occlusion.…”

Section: Essentials Of Radiological Interventions[1-4]supporting

confidence: 81%

“Beyond saving lives”: Current perspectives of interventional radiology in trauma

Singh

Kumar

et al. 2017

WJR

View full text Add to dashboard Cite

Interventional radiology (IR) has become an integral part in the management of traumatic injuries. There is an ever-increasing role of IR in traumatic injuries of solid abdominal organs, pelvic and peripheral arteries to control active bleeding by therapeutic embolization or vascular reconstruction using stent grafts. Traditionally, these endovascular treatments have been offered to hemodynamically stable patients. However, in recent times endovascular approach has become preferable to surgery even in hemodynamically unstable patients with injury of surgically difficult-to-access sites. With shifting trends towards non operative management coupled with availability of the current state-of-the-art equipments, hardware and technical expertise, IR has gained an impeccable role in trauma management. However, due to lack of awareness and widespread acceptance, IR continues to remain an ocean of unexplored potentialities.

show abstract

Section: Essentials Of Radiological Interventions[1-4]supporting

confidence: 81%

“Beyond saving lives”: Current perspectives of interventional radiology in trauma

Singh

Kumar

et al. 2017

WJR

View full text Add to dashboard Cite

show abstract

“…(4, 6–16) In this study, we sought to better understand how patients with a AAST renal grade 3 and 4 injury fare following discharge from a level I trauma center (HMC) by examining readmission rates using the statewide CHARS database. In doing so, we are the first to report statewide readmission rates for renal trauma.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, there is limited data regarding management efficacy following initial management after renal trauma with previous authors noting wide variance in follow-up visits (6–94%). (4, 6–16) A major reason for this is the regionalization of trauma care, which may limit a patient’s ability to comply with follow-up given the distance of travel from the patient’s home. We hypothesize that examining outcomes based on the index institution alone may be insufficient, as some patients might present to a local hospital following discharge rather than the index trauma center.…”

Section: Introductionmentioning

confidence: 99%

Readmission after treatment of Grade 3 and 4 renal injuries at a Level I trauma center

Winters

Wessells

Voelzke

2016

Journal of Trauma and Acute Care Surgery

View full text Add to dashboard Cite

Purpose One criticism of the existing renal trauma research is the limited outpatient follow-up after index hospitalization. We assessed readmission rates following treatment for AAST grade 3 and 4 renal injury using the Comprehensive Hospital Abstract Reporting System (CHARS). Materials and Methods We evaluated all patients with AAST grade 3 and 4 renal injuries admitted to Harborview Medical Center (HMC) between 1998–2010, the only level 1 trauma center in Washington state. Grade 4 renal injuries were stratified by collecting system laceration (CSL) or segmental vascular injury (SVI). Data was abstracted from the CHARS database for readmissions to any Washington State hospital within six months of renal injury. Clinical variables, diagnoses, and procedures were queried based on ICD-9 codes. Results 477 grade 3 and 159 grade 4 renal injuries were initially treated at HMC. On admission, 111 patients required intervention: 75/477 (16%) grade 3 and 36/159 (23%) grade 4 injuries. Within six months of index hospitalization, 86/477 (18%) grade 3 and 38/159 (24%) grade 4 patients were readmitted to any WA state hospital. 80% of grade 3 injuries and 66% of grade 4 injuries returned to HMC compared to secondary hospitals (p=0.08). At readmission, 19/86 grade 3 (22%) and 16/38 grade 4 (42%) injuries had a urologic diagnosis. Subsequent procedural intervention was required on readmission in 6/86 (7%) of grade 3 and 5/38 (13%) of grade 4 renal injuries (all CSL injuries). Conclusions A subset of patients treated for grade 3 and 4 renal trauma will be readmitted for further management. While urologic diagnoses and additional procedures may be low overall, readmission to outside hospitals may preclude accurate determination of renal trauma outcomes. Based on these data, patients with grade 4 CSL injuries appear to be at the highest risk for readmission and to require a subsequent urologic procedure.

show abstract

“…At present, embolization has an important role in the non-operative management of renal trauma in hemodynamically stable patients. [41,42] However, currently there are no validated criteria to identify patients who require angioembolisation and its use in renal trauma remains heterogeneous.…”

Section: Discussionmentioning

confidence: 99%

The effect of biological sealants and adhesive treatments on matrix metalloproteinase expression during renal injury healing

et al. 2017

View full text Add to dashboard Cite

BackgroundRenal injuries are relatively common in cases of abdominal trauma. Adhesives and sealants can be used to repair and preserve damaged organs. Using a rat model, this study explores the activity of different matrix metalloproteinases (MMP) during the healing of renal injuries treated by two biological adhesives (TachoSil and GelitaSpon) and a new synthetic elastic cyanoacrylate (Adhflex).MethodsRenal traumatic injuries were experimentally induced in 90 male Wistar rats by a Stiefel Biopsy Punch in the anterior aspect of the left kidney. Animals were divided into five groups: 1, sham non-injured (n = 3); 2, non-treated standard punch injury (n = 6); 3, punch injury treated with TachoSil (n = 27); 4, punch injury treated with GelitaSpon (n = 27); and, 5, punch injury treated with Adhflex (n = 27). Wound healing was evaluated 2, 6, and 18 days after injury by determining the expression of MMPs, and the histopathological evolution of lesions.FindingsHistologically, the wound size at 6 days post-injury was larger in Adhflex-treated samples than in the other treatments, but the scarring tissue was similar at 18 days post-injury. Only the MMPs subtypes 1, 2, 8, 9, and 13 were sufficiently expressed to be quantifiable. Both time since injury and treatment type had a significant influence on MMPs expression. Two days after injury, the expression of MMP8 and MMP9 was predominant. MMP2 expression was greater 6 days after injury. The Adhflex-treated group had a significantly higher MMPs expression than the other treatment groups at all healing stages.ConclusionsAll three sealant treatments induced almost similar expression of MMPs than untreated animals indicating a physiological healing process. Given that all renal trauma injuries must be considered emergencies, both biological and synthetic adhesives, such as Adhflex, should be considered as a treatment options.

show abstract

Successful Nonoperative Management of the Most Severe Blunt Renal Injuries

Abstract: Hemodynamically stable patients with a grade IV or V BRI were safely managed nonoperatively. Nonoperative management failed for only 6.5% of patients owing to renal-related injuries, and three-fourths of the entire population retained their kidneys.

Cited by 108 publications

References 51 publications

“Beyond saving lives”: Current perspectives of interventional radiology in trauma

“Beyond saving lives”: Current perspectives of interventional radiology in trauma

Readmission after treatment of Grade 3 and 4 renal injuries at a Level I trauma center

The effect of biological sealants and adhesive treatments on matrix metalloproteinase expression during renal injury healing

Contact Info

Product

Resources

About