Applicability of blunt renal trauma classification of Japanese Association for the Surgery of Trauma (JAST)

Abstract

Objectives:The Japanese Association for the Surgery of Trauma (JAST) classification is widely applied to select strategies in the treatment of blunt renal trauma in Japan. We retrospectively investigated the applicability of the JAST classification. Methods: The JAST classification comprises type I (subcapsular), type II (superficial), type III (deep) and pedicle vessel traumas. According to these criteria, we reviewed 70 patients with blunt renal trauma (types I, II, III and PV; n = 23, 22, 22 and 3, respectively) who were admitted to our institution between 1991 and 2007. Results: All patients with type I trauma were managed conservatively and three patients with PV trauma underwent nephrectomy. Whereas two patients with underlying acquired cystic disease of the kidney underwent nephrectomy among type II trauma, the other patients were treated conservatively. As four patients with type III trauma underwent nephrectomy, injury type subclass and hemorrhage severity were significant prognostic factors indicating the need for nephrectomy in this group. Since we introduced transcatheter arterial embolization in 1999, none of our patients have needed nephrectomy due to a hemorrhage, but one patient underwent nephrectomy because of persistent urine leakage. Conclusion: Injury type and the hemorrhage severity are useful for determining treatment strategy. After the introduction of transcatheter arterial embolization, the proportion of nephrectomies due to exsanguination decreased and urine leakage also seems to be more important as a prognostic factor.

Experience of renal artery embolization in patients with blunt kidney trauma

“…Sixteen patients were treated successfully with transcatheter arterial embolization in the 2 hospitals, and 15 of them were classified as type III renal injury. Thus, the authors believe that nephrectomy should be avoided in such patients because of the benefits offered by embolization [ 22 , 23 ].…”

Management trends, angioembolization performance and multiorgan injury indicators of renal trauma from Japanese administrative claims database

“…In general, conservative management for renal trauma is widely used today, and it is reported that most grade I and II, and stable parenchymal grade III and IV injuries were managed without any interventions. 2,12 In contrast, nephrectomy was carried out in 3.1% of all patients with renal trauma and 6.7% of patients initially undergoing AE. This shows that timely nephrectomy remains an important last resort despite the fact that AE has advanced.…”

Experience of renal artery embolization in patients with blunt kidney trauma

“…Sixteen patients were treated successfully with transcatheter arterial embolization in the 2 hospitals, and 15 of them were classified as type III renal injury. Thus, the authors believe that nephrectomy should be avoided in such patients because of the benefits offered by embolization [22,23].…”