Factors predicting the outcome of non-operative management of high-grade blunt renal trauma

Maarouf, Aref; Ahmed, AF; Shalaby, Essam; Badran, Yasser; Salem, Emad A.; Zaiton, Fatma

doi:10.1016/j.afju.2014.11.006

Cited by 20 publications

(17 citation statements)

References 20 publications

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“…The majority of patients in our study (83.8%) were male, and a similar situation can be found in other renal trauma studies [5,6,8,[14][15][16]. The age at admission was 23.9 ± 0.6 years (range = 5-61 years), and adolescents (age range 11-20 years) were the largest age group (30 cases).…”

Section: Discussionsupporting

confidence: 87%

Renal trauma: a 5-year retrospective review in single institution

et al. 2020

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Background Renal trauma occurs in up to 5% of all trauma cases and accounts for 24% of abdominal solid organ injuries. Renal trauma management has evolved over the past decades, and current management is transitioning toward more conservative approaches for the majority of hemodynamically stable patients. The objective of this study was to analyze the mechanism of injury, management, and outcome in renal trauma. Methods Patients diagnosed with renal trauma in Makassar, Indonesia, from January 2014 to December 2018 were identified retrospectively by the ICD-10 code. Data were collected from medical records. Imaging was classified by radiologists. Variables analyzed included age, sex, mechanism of injury, degree of renal trauma, related organ injury, management, and outcome. Results Out of the 68 patients identified, the average age was 23.9 ± 0.6 years, and most were male (83.8%). Blunt trauma accounted for 89.7% of all cases. The most common renal injuries were grade IV (42.6%), and 14% of the cases had no hematuria. Most patients were treated with non-operative management (NOM). Nephrectomy was performed in 16.2% of cases, and 5.9% of cases underwent renorrhaphy. It was found that 58.8% of cases had isolated renal trauma, and the overall mortality rate (2.9%) was due to related injuries. Conclusions The majority of blunt and penetrating renal trauma cases that are hemodynamically stable have a good outcome when treated with NOM. The presence of injury in other important organs both intra- and extra-abdominally aggravates the patient’s condition and affects the prognosis.

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Section: Discussionsupporting

confidence: 87%

Renal trauma: a 5-year retrospective review in single institution

et al. 2020

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“…13,14 In 2015 European Association of Urology updated these guidelines and stated that in haemodynamically stable patients, non-operative management is recommended for the management of all renal injuries including grade IV and grade V. 15 Maaroufet al studied 206 patients with renal injuries on non-operative management with successful outcome in 189 cases (92.75%). 16 Eight cases out of these 189 required angioembolisation while 181 cases were managed without any intervention. Wood et al reported that after operative management, 21% had pancreatic complications, 57% had non-pancreatic complications, and 11% were readmitted.…”

Section: Discussionmentioning

confidence: 99%

A study of role of non-operative management in blunt abdominal trauma with solid organ injury

et al. 2018

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Background: The present study of role of non-operative management in blunt abdominal trauma with solid organ injury was done to assess the feasibility and safety of non-operative management in hemodynamically stable patients and identify the causes, predictive factors to delineate the rate of non-operative management failure.Methods: A longitudinal observational study was carried out from September 2013 to November 2015. All cases of blunt trauma abdomen with ultrasonological e/o solid organ injury and were hemodynamically stable were included in study.Results: Total 138 cases presented with a history of blunt trauma abdomen of which 56 cases had ultrasonological evidence of solid organ injury. 8 cases were excluded as 6 of these were hemodynamically unstable at presentation while 1 had bowel perforation and another had severe head injury all requiring operative management. Maximum cases were of age group 21-30 years (41.66%) and 31-40 years (31.25%). 42 (87.5%) cases were male and 6 (12.5%) cases of 48 were females. 28 (66.67%) cases presented as Road Traffic Accident. 28 (66.67%) cases had abdominal pain as the commonest symptom while tenderness in 38 (79.17%) cases and tachycardia in 30 (75%) cases was the predominant sign. Most injuries were seen in spleen 23 (47.92%) cases f/b Liver with 14 (29.12%). Conservative management was successful in 40 (83.33%) cases and failed in 8 (16.67%) cases. Mortality of the study was 1 (2.08%) case.Conclusions: Non-operative strategy is a successful approach in patients who are hemodynamically stable and authors strongly recommend it.

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“…This supports that most haemodynamically stable highgrade blunt renal injuries can be managed conservatively, as outlined in the European Association of Urology urological trauma guidelines and other studies. [12][13][14][15][16][17][18] Complications of conservative management were minimal, again supporting urological trauma guidelines.…”

Section: Discussionmentioning

confidence: 68%

“…[12][13][14][15][16][17][18] Complications of conservative management were minimal, again supporting urological trauma guidelines. Minimally invasive endoscopic management with retrograde ureteric stenting in collecting system injury was performed to manage one complication and prophylactic stenting was not performed.…”

Section: Discussionmentioning

confidence: 69%

Renal trauma: a 3‐year audit from a Gold Coast trauma centre

Mansbridge

Ryan

Hill

et al. 2019

ANZ Journal of Surgery

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Background: Limited data exists on the Australian epidemiology of renal trauma, with very few studies published in the literature. The authors aim to detail the trends of renal trauma in the coastal city of the Gold Coast. Methods: Retrospective data collection yielded 81 patients who sustained renal trauma from our 3-year period. Data included information on demographics, mechanism, American Association for the Surgery of Trauma (AAST) grade, presence of haematuria, associated injuries, management, and complications. Results: Male patients accounted for 83% (n = 67) of cases, and the average age of all injuries was 36 years. Low-grade AAST Grade I-III injuries comprised of 76% (n = 62) of injuries, AAST Grade IV contributed to 20% (n = 16) and 4% (n = 3) of injuries were AAST Grade V. The most common mechanism of injury was road accidents accounting for 35% (n = 28) followed by fall-related injuries (26%, n = 21). Other mechanisms included sportrelated (13.5%, n = 11), non-motorized bicycle injuries (8.5%, n = 7), alleged assault (8.5%, n = 7), pedestrian injuries (5%, n = 4) and horse-related injuries (2%, n = 2). Ninety-six percent (n = 78) of kidney injuries were managed conservatively. Of the patients requiring intervention, all were AAST Grade V kidney injuries. Conclusion: Males accounted for the majority of renal trauma cases, similar to the 3:1 ratio of male-to-female injuries found in other studies. In line with other studies, renal trauma reviewed on the Gold Coast also revealed road trauma as the leading cause, closely followed by falls. The majority of high-grade renal trauma was managed conservatively.

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Factors predicting the outcome of non-operative management of high-grade blunt renal trauma

Cited by 20 publications

References 20 publications

Renal trauma: a 5-year retrospective review in single institution

Renal trauma: a 5-year retrospective review in single institution

A study of role of non-operative management in blunt abdominal trauma with solid organ injury

Renal trauma: a 3‐year audit from a Gold Coast trauma centre

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