Nonoperative Management of Grade 5 Renal Injury in Children: Does It Have a Place?

Eassa, Waleed; El-Ghar, M. Abo; Jednak, Roman; El‐Sherbiny, Mohamed

doi:10.1016/j.eururo.2009.02.001

Cited by 53 publications

(39 citation statements)

References 16 publications

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“…Urologic diagnoses at readmission included acute renal failure (7), UTI site not specified (7), hematuria (5), pyelonephritis (5), kidney, other (3), and unspecified disorders of kidney/ureter (3). Average time to readmission did not vary significantly between grade 3 and 4 renal trauma patients; however, multiple readmissions were more common in grade 4 patients (34% [13/38] vs. 26% [22/86], p=0.09).…”

Section: Resultsmentioning

confidence: 99%

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Readmission after treatment of Grade 3 and 4 renal injuries at a Level I trauma center

Winters

Wessells

Voelzke

2016

Journal of Trauma and Acute Care Surgery

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Purpose One criticism of the existing renal trauma research is the limited outpatient follow-up after index hospitalization. We assessed readmission rates following treatment for AAST grade 3 and 4 renal injury using the Comprehensive Hospital Abstract Reporting System (CHARS). Materials and Methods We evaluated all patients with AAST grade 3 and 4 renal injuries admitted to Harborview Medical Center (HMC) between 1998–2010, the only level 1 trauma center in Washington state. Grade 4 renal injuries were stratified by collecting system laceration (CSL) or segmental vascular injury (SVI). Data was abstracted from the CHARS database for readmissions to any Washington State hospital within six months of renal injury. Clinical variables, diagnoses, and procedures were queried based on ICD-9 codes. Results 477 grade 3 and 159 grade 4 renal injuries were initially treated at HMC. On admission, 111 patients required intervention: 75/477 (16%) grade 3 and 36/159 (23%) grade 4 injuries. Within six months of index hospitalization, 86/477 (18%) grade 3 and 38/159 (24%) grade 4 patients were readmitted to any WA state hospital. 80% of grade 3 injuries and 66% of grade 4 injuries returned to HMC compared to secondary hospitals (p=0.08). At readmission, 19/86 grade 3 (22%) and 16/38 grade 4 (42%) injuries had a urologic diagnosis. Subsequent procedural intervention was required on readmission in 6/86 (7%) of grade 3 and 5/38 (13%) of grade 4 renal injuries (all CSL injuries). Conclusions A subset of patients treated for grade 3 and 4 renal trauma will be readmitted for further management. While urologic diagnoses and additional procedures may be low overall, readmission to outside hospitals may preclude accurate determination of renal trauma outcomes. Based on these data, patients with grade 4 CSL injuries appear to be at the highest risk for readmission and to require a subsequent urologic procedure.

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Section: Resultsmentioning

confidence: 99%

“…(2–5) As renal trauma grading continues to evolve, evidence based management of renal trauma focusing on outcomes is of paramount importance. Further, accurate long-term follow up after renal trauma management is essential to detect injury sequelae including urinoma, infection, and hypertension.…”

Section: Introductionmentioning

confidence: 99%

Readmission after treatment of Grade 3 and 4 renal injuries at a Level I trauma center

Winters

Wessells

Voelzke

2016

Journal of Trauma and Acute Care Surgery

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“…In un recente renal function [40]. In a very recent paper, Eassa et al [45] stated that conservative management may also have a role in grade V injuries, with nephrectomy being performed in only 22% cases of major vascular trauma, in some cases deferred to 21 days after injury. It is evident that the only absolute indication for immediate exploratory surgery is the presence of "uncontrollable" active bleeding (Fig.…”

Section: Gestione Del Trauma Renalementioning

confidence: 98%

“…All other major lesions, from shattered kidney to avulsion of the ureteropelvic junction, are not strictly indications for immediate surgery, and surgery may be deferred. Finally, it should also be noted that surgical repair of renal injuries may initially be avoided in favour of more recent and less invasive therapeutic procedures, such as embolisation during arteriography or percutaneous nephrostomy, and thus be used as the last resort once the ineffectiveness or unfeasibility of these lavoro del 2009, Eassa et al [45], affermano che il management conservativo può avere un ruolo anche nei traumi di grado V, ricorrendo in caso di trauma vascolare maggiore alla nefrectomia solo nel 22% dei casi, peraltro differita anche di 21 giorni. È evidente, in definitiva, che l'unica indicazione assoluta alla esplorazione chirurgica immediata è rappresentata dalla sola presenza di emorragia in atto, incontrollabile (Fig.…”

Section: Gestione Del Trauma Renaleunclassified

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Multidetector computed tomography in the diagnosis and management of renal trauma

et al. 2010

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Renal injuries fall within the broad and complex subject of retroperitoneal trauma. Although their computed tomography (CT) features have been known for a while, the timing, diagnostic approach and management are still debated. In addition, some areas of uncertainty remain regarding timing, indications and imaging modalities to be used in the follow-up of these patients. The purpose of this paper is to review the impact of CT on the management of renal trauma, stressing the importance of this technique and the role of the radiologist in the timing of decisions. Finally, we discuss the diagnostic approach to the followup of renal trauma.Keyword Renal injuries · CT · Management URO-GENITAL RADIOLOGY RADIOLOGIA URO-GENITALE Radiol med (2010) 115:936-949

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Urinary tract trauma

2015

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Nonoperative Management of Grade 5 Renal Injury in Children: Does It Have a Place?

Cited by 53 publications

References 16 publications

Readmission after treatment of Grade 3 and 4 renal injuries at a Level I trauma center

Readmission after treatment of Grade 3 and 4 renal injuries at a Level I trauma center

Multidetector computed tomography in the diagnosis and management of renal trauma

Urinary tract trauma

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