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 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

Urine leaks in children sustaining blunt renal trauma

“…Nonetheless, case reports of severe isolated kidney injuries have been reported, 16 as well as retrospective studies suggesting isolated renal injuries are more common in younger children. 17 In this context, the finding that isolated BRT is independently associated with urine leaks in children indicates that this population may benefit from greater clinical suspicion, earlier diagnostic evaluation, and closer monitoring. Specifically, although it did not meet statistical significance, our study showed that children developing urine leaks had a lower ISS (n = 17) relative to those who did not (n = 24), which likely reflects isolated BRT having more frequent urine leaks yet lower ISS.…”

“…With regard to other identified risk factors, isolated BRT is rarer and often presumed a more minor injury, 14,15 leading potentially to less timely evaluation. Nonetheless, case reports of severe isolated kidney injuries have been reported, 16 as well as retrospective studies suggesting isolated renal injuries are more common in younger children 17 . In this context, the finding that isolated BRT is independently associated with urine leaks in children indicates that this population may benefit from greater clinical suspicion, earlier diagnostic evaluation, and closer monitoring.…”

Characteristics and outcomes of severe sports-related injury in children and adults: a nationwide cohort study in Japan

“…Abdominal injuries are more common in children due to their flexible rib cage and less developed abdominal muscles [30]. Previous studies demonstrated that severe sports-related abdominal injuries, such as renal injury, are more likely to occur as in isolated injury in children [31,32]. A previous study that analyzed an international trauma database reported that head, chest, spinal and pelvic injuries were common in major trauma in winter sports [24].…”