Comparison of nonoperative and surgical management of renal trauma

Bjurlin, Marc A.; Fantus, Richard J.; Fantus, Richard J; Villines, Dana

doi:10.1097/ta.0000000000001316

Cited by 38 publications

(16 citation statements)

References 26 publications

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“…Previous studies demonstrated the AAST grade, and other indications for laparotomy were associated with nephrectomy, which is consistent with our results [ 26 , 27 ]. As high-grade renal trauma is associated with a higher risk of treatment failure in patients undergoing non-operative management in comparison to cases of lower-grade renal trauma, an appropriate assessment of the renal injury is important for selecting the appropriate management [ 16 ]. Patients with concomitant thoracic injury were less likely to receive nephrectomy, possibly because angiography and transcatheter arterial embolization (TAE) were less invasive and because it is relatively easy to control bleeding in cases involving trauma-induced coagulopathy and respiratory distress due to chest trauma [ 28 – 30 ].…”

Section: Discussionmentioning

confidence: 99%

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

Nakao

Katayama

Hirayama³

et al. 2020

World J Emerg Surg

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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.

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Section: Discussionmentioning

confidence: 99%

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

Nakao

Katayama

Hirayama³

et al. 2020

World J Emerg Surg

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“…Moolman et al reported that 60% of patients with a penetrating renal injury were managed conservatively without the need for surgical intervention [ 4 ]. Despite the benefits associated with conservative management, certain cases require intervention; for example, a hemodynamically unstable patient and the presence of a foreign body that must be removed [ 5 ]. In this case, the patient had a nail within the right kidney that had to be extracted to avoid possible complications, including infection, encrustation, and stone formation.…”

Section: Discussionmentioning

confidence: 99%

Nail Gun Penetrating Renal Injury: A Case Report

Alothman

Alhajress

Elshaer

et al. 2022

Cureus

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The kidney is the genitourinary organ most affected by trauma, although the retroperitoneal location provides some protection. Renal injuries are classified according to the mechanism of trauma. Most of the penetrating renal injury cases in the literature are due to knife stabbing or handguns. We present an interesting case of a 22-year-old male with a penetrating renal injury caused by an electric nail gun. There was no report of a similar case in the literature.

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“…Results have shown that renal salvage is higher compared to exploration; however, those managed conservatively may require minimally invasive intervention. 3,14,26 Grade 5 injuries (Fig. 4)…”

Section: Grade 3 Injuriesmentioning

confidence: 99%