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

Abstract

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 3550 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 the 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 grades 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 the thorax (adjusted OR 0.46) and spleen (adjusted OR 2.07), AAST grades 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.

Evaluation of urinary extravasation after non-operative management of traumatic renal injury: a multi-center retrospective study

“…The median age of the patients with renal traumatic injury in our study was similar to that of a nationwide study in Japan [ 15 ] but was higher than that of a study in the United States [ 16 ]. The median ISS and mortality in our study were lower than those of previous studies in Japan and the United States.…”

Evaluation of Urinary Extravasation After Non-Operative Management of Traumatic Renal Injury: A Multi-Center Retrospective Study

“…The median age of the patients with renal traumatic injury in our study was similar to that of a nationwide study in Japan 15 but was higher than that of a study in the United States. 16 The median ISS and mortality in our study were lower than those of previous studies in Japan and the United States.…”

Management of Adult Blunt Renal Injury: A 10-Year Retrospective Review at a Single Institution

“…The kidney is only held in position by the renal pelvis and vascular pedicle, therefore, it is particularly vulnerable to decelerating injuries, such as falls, and motor vehicle collisions [3]. Studies have shown that falls and car accidents are the most common causes of renal injury [2,5,18,19]. In a retrospective study over 15 years, using data from the Japan Trauma Data Bank, patients with blunt renal trauma were identified (n = 3,550) and falls accounted for 34% of injuries, and car accidents accounted for 15.7% [18].…”

“…Studies have shown that falls and car accidents are the most common causes of renal injury [2,5,18,19]. In a retrospective study over 15 years, using data from the Japan Trauma Data Bank, patients with blunt renal trauma were identified (n = 3,550) and falls accounted for 34% of injuries, and car accidents accounted for 15.7% [18]. Another retrospective study over 8 years using the Taiwan National Trauma Bank (n = 10,096) reported that the most common mechanisms of renal injury were motor vehicle accidents (49.4%) and falls (27.4%) [19].…”

“…Motor vehicle accidents have been reported to be the most common cause of high-grade renal injury [2,5]. In cases of renal injury caused by high-energy mechanisms such as falls or traffic accidents, the incidence of high-grade renal injury is reported to be between 47.4% and 76% [1,2,18,20]. The mechanism of injury in the present study showed that 32 patients (48.5%) had experienced a fall, and 20.6% had been in a motor vehicle accident.…”