Impact of Trauma Center Designation and Interfacility Transfer on Renal Trauma Outcomes: Evidence for Universal Management

Hirayama³

et al. 2020

World J Emerg Surg

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: Discussionsupporting

confidence: 84%

Section: Methodsmentioning

confidence: 99%

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

Hirayama³

et al. 2020

World J Emerg Surg

show abstract

“…Blunt renal trauma accounted for 1.0% of all blunt injuries registered in the JTDB, which was a similar rate to that reported in previous studies. 17,19 As the number of institutions participating in the JTDB increased, the number of patients with blunt renal trauma increased. Patients of ≥65 years of age accounted for 26.1% of our total cohort and this proportion increased signi cantly in each period.…”

Section: Discussionmentioning

confidence: 99%

“…We included blunt trauma patients with traumatic renal injuries, which were identi ed by AIS codes using the method described by Kuan et al 12 AIS codes were converted to AAST renal injury grades, excluding codes that did not match. 15,16,17 We excluded patients who were in cardiac arrest on hospital arrival, and those whose records were missing information on age, sex, vital signs on arrival, ISS, or mortality. We de ned cardiac arrest on hospital arrival as a systolic blood pressure of 0 mmHg or a heart rate of 0 bpm on hospital arrival.…”

Section: Participantsmentioning

confidence: 99%

“…However, the method to identify renal trauma has been successfully applied in multiple studies. 15,16,17 Third, because JTDB does not include data on TAE for renal injury and the failure of non-operative management, we could not assess these factors. Lastly, our results may not be fully applicable to other areas that have different healthcare systems, legislation, and age distribution of population.…”

Section: Limitationsmentioning

confidence: 99%

See 1 more Smart Citation

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

Hirayama

et al. 2020

Preprint

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

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Characteristics and outcomes of pediatric blunt renal trauma: a nationwide cohort study in Japan

Eur J Trauma Emerg Surg

Hirayama

et al. 2021