Traumatic renal injury: Five-year experience at a major trauma centre in South Africa

Salem, Mark; Urry, R.J.; Kong, Victor; Clarke, Damian; Bruce, J L; Laing, G L

doi:10.1016/j.injury.2019.10.034

Cited by 15 publications

(19 citation statements)

References 15 publications

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“…A study from South Africa, a setting similar to the Indian LMIC context, demonstrated high nephrectomy rates of 40% for grade IV and 89% for grade V in predominantly blunt renal trauma [ 20 ]. Contrary to this, another South African study from a tertiary level major trauma centre utilising endovascular and endourological interventions for trauma management, demonstrated nephrectomy rates of 10.5% for grade IV and 25% for grade V patients with blunt renal trauma [ 21 ]. A genitourinary trauma study by the AAST demonstrated nephrectomy rates of 15% for grade IV and 62% for grade V [ 10 ], and a Canadian study by Mann et al demonstrated only a 4% nephrectomy rate for high-grade renal trauma [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Renal Trauma in Indian Urban Tertiary Healthcare Centres: A Multicentre Cohort Study

et al. 2021

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Background Renal trauma is present in 0.5–5% of patients admitted for trauma. Advancements in radiologic imaging and minimal-invasive techniques have led to decreased need for surgical intervention. We used a large trauma cohort to characterise renal trauma patients, their management and outcomes. Methods We analysed “Towards Improved Trauma Care Outcomes in India” cohort from four urban tertiary public hospitals in India between 1st September 2013 and 31st December 2015. The data of patients with renal trauma were extracted using International Classification of Diseases 10 codes and analysed for demographic and clinical details. Results A total of 16,047 trauma patients were included in this cohort. Abdominal trauma comprised 1119 (7%) cases, of which 144 (13%) had renal trauma. Renal trauma was present in 1% of all the patients admitted for trauma. The mean age was 28 years (SD-14.7). A total of 119 (83%) patients were male. Majority (93%) were due to blunt injuries. Road traffic injuries were the most common mechanism (53%) followed by falls (29%). Most renal injuries (89%) were associated with other organ injuries. Seven of the 144 (5%) patients required nephrectomy. Three patients had grade V trauma; all underwent nephrectomy. The 30-day in-hospital mortality, in patients with renal trauma, was 17% (24/144). Conclusion Most renal trauma patients were managed nonoperatively. 89% of patients with renal trauma had concomitant injuries. The renal trauma profile from this large cohort may be generalisable to urban contexts in India and other low- and middle-income countries.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Renal Trauma in Indian Urban Tertiary Healthcare Centres: A Multicentre Cohort Study

et al. 2021

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“…However, conservative management of patients with grade IV or V injuries who are hemodynamically unstable remains controversial [2]. In most high-grade renal injury cases, nephrectomy remains a possibility even though successful NOM is possible [10]. However, recent developments in imaging technology and in the available treatment options have decreased the need for surgical interventions, allowing kidney preservation in most cases [11].…”

Section: Discussionmentioning

confidence: 99%

Non-Operative Management with Angioembolization of Grade IV and V Renal Injuries in a Hybrid Emergency Room System

et al. 2021

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Renal injuries occur in more than 10% of patients who sustain blunt abdominal injuries. Non-operative management (NOM) is the established treatment strategy for lowgrade (I–III) renal injuries. However, despite some evidence that NOM can be successfully applied to high-grade (IV, V) renal injuries, it remains unclear whether NOM is appropriate in such cases. The authors report two cases of high-grade renal injuries that underwent NOM after embolization in a hybrid emergency room (ER) system with a 24/7 in-house interventional radiology (IR) team. A 29-year-old male visited Wonkwang University Hospital Regional Trauma Center complaining of right abdominal pain after being hit by a rope. Computed tomography (CT) was performed 16 minutes after arrival, and the CT scan indicated a grade V right renal injury. Arterial embolization was initiated within 31 minutes of presentation. A 56-year-old male was transferred to Wonkwang University Hospital Regional Trauma Center with a complaint of right flank pain. He had initially presented to a nearby hospital after falling from a 3-m height. Thanks to the key CT images sent from the previous hospital prior to the patient’s arrival, angiography was performed within 8 minutes of the patient’s arrival and arterial embolization was completed within 25 minutes. Both patients were treated successfully through NOM with angioembolization and preserved kidneys. Hematoma in the first patient and urinoma in the second patient resolved with percutaneous catheter drainage. The authors believe that the hybrid ER system with an in-house IR team could contribute to NOM and kidney preservation even in high-grade renal injuries.

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“…The historical experience of mandatory laparotomies has been supplanted by selective non-operative management (NOM) based on clinical risk factors and advanced diagnostic imaging [1][2][3][4][5][6][7] . While blunt renal trauma has long been managed conservatively with fantastic results, conservative management of penetrating trauma to the kidney has only more recently been explored [8][9][10][11][12][13][14] . The candidacy for non-operative management, as well as the risk factors for failure, remain poorly de ned 7,13,14 .…”

Section: Introductionmentioning

confidence: 99%

Penetrating renal injuries: an observational study of non operative management and the impact of opening Gerota’s fascia

Clements

Ball

Nicol

et al. 2022

Preprint

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Background: Non-operative management has become increasingly popular in the treatment of renal trauma. While data is robust in blunt mechanisms, the role of non-operative management in penetrating trauma is less clear. Additionally, there is a paucity of data comparing gunshot and stab wounds.Methods: A retrospective review of patients admitted to a high-volume level 1 trauma center (Groote Schuur Hospital, Cape Town) with penetrating abdominal trauma was performed. Patients with renal injuries were identified and compared based on mechanism (gunshot (GSW) versus stab) and management strategy (operative vs non operative). Primary outcomes of interest were mortality and failure of non-operative management. Secondary outcomes of interest were nephrectomy rates, Clavien-Dindo complication rate, hospital length of stay, and overall morbidity rate.Results: A total of 150 patients with renal injuries were identified (82 GSW, 68 stab). Overall, 55.2% of patients required emergent/urgent laparotomy. GSWs were more likely to cause grade V injury and concurrent intra-abdominal injuries (p>0.05). The success rate of non-operative management was 91.6% (89.9% GSW, 92.8% stab, p=0.64). The absence of hematuria on point of care testing demonstrated a negative predictive value of 98.4% (95% CI=96.8%-99.2%). All but 1 patient who failed non-operative management had associated intra-abdominal injuries requiring surgical intervention. Opening of Gerota’s fascia resulted in nephrectomy in 55.6% of cases. There were no statistically significant risk factors for failure of non-operative management identified on univariate logistic regression. Conclusions: NOM of penetrating renal injuries can be safely and effectively instituted in both gunshot and stab wounds with a very low number of patients progressing to laparotomy. Most patients fail NOM for associated injuries. During laparotomy, the opening of Gerota’s fascia may lead to increased risk of nephrectomy. Ongoing study with larger populations is required to develop effective predictive models of patients who will fail NOM.

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Traumatic renal injury: Five-year experience at a major trauma centre in South Africa

Cited by 15 publications

References 15 publications

Outcomes of Renal Trauma in Indian Urban Tertiary Healthcare Centres: A Multicentre Cohort Study

Outcomes of Renal Trauma in Indian Urban Tertiary Healthcare Centres: A Multicentre Cohort Study

Non-Operative Management with Angioembolization of Grade IV and V Renal Injuries in a Hybrid Emergency Room System

Penetrating renal injuries: an observational study of non operative management and the impact of opening Gerota’s fascia

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