TY - JOUR
T1 - Contemporary management of high-grade renal trauma
T2 - Results from the American Association for the Surgery of Trauma Genitourinary Trauma study
AU - Keihani, Sorena
AU - Xu, Yizhe
AU - Presson, Angela P.
AU - Hotaling, James M.
AU - Nirula, Raminder
AU - Piotrowski, Joshua
AU - Dodgion, Christopher M.
AU - Black, Cullen M.
AU - Mukherjee, Kaushik
AU - Morris, Bradley J.
AU - Majercik, Sarah
AU - Smith, Brian P.
AU - Schwartz, Ian
AU - Elliott, Sean P.
AU - Desoucy, Erik S.
AU - Zakaluzny, Scott
AU - Thomsen, Peter B.
AU - Erickson, Bradley A.
AU - Baradaran, Nima
AU - Breyer, Benjamin N.
AU - Miller, Brandi
AU - Santucci, Richard A.
AU - Carrick, Matthew M.
AU - Hewitt, Timothy
AU - Burks, Frank N.
AU - Kocik, Jurek F.
AU - Askari, Reza
AU - Myers, Jeremy B.
N1 - Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc.
PY - 2018/3/1
Y1 - 2018/3/1
N2 - BACKGROUND The rarity of renal trauma limits its study and the strength of evidence-based guidelines. Although management of renal injuries has shifted toward a nonoperative approach, nephrectomy remains the most common intervention for high-grade renal trauma (HGRT). We aimed to describe the contemporary management of HGRT in the United States and also evaluate clinical factors associated with nephrectomy after HGRT. METHODS From 2014 to 2017, data on HGRT (American Association for the Surgery of Trauma grades III-V) were collected from 14 participating Level-1 trauma centers. Data were gathered on demographics, injury characteristics, management, and short-term outcomes. Management was classified into three groups-expectant, conservative/minimally invasive, and open operative. Descriptive statistics were used to report management of renal trauma. Univariate and multivariate logistic mixed effect models with clustering by facility were used to look at associations between proposed risk factors and nephrectomy. RESULTS A total of 431 adult HGRT were recorded; 79% were male, and mechanism of injury was blunt in 71%. Injuries were graded as III, IV, and V in 236 (55%), 142 (33%), and 53 (12%), respectively. Laparotomy was performed in 169 (39%) patients. Overall, 300 (70%) patients were managed expectantly and 47 (11%) underwent conservative/minimally invasive management. Eighty-four (19%) underwent renal-related open operative management with 55 (67%) of them undergoing nephrectomy. Nephrectomy rates were 15% and 62% for grades IV and V, respectively. Penetrating injuries had significantly higher American Association for the Surgery of Trauma grades and higher rates of nephrectomy. In multivariable analysis, only renal injury grade and penetrating mechanism of injury were significantly associated with undergoing nephrectomy. CONCLUSION Expectant and conservative management is currently utilized in 80% of HGRT; however, the rate of nephrectomy remains high. Clinical factors, such as surrogates of hemodynamic instability and metabolic acidosis, are associated with nephrectomy for HGRT; however, higher renal injury grade and penetrating trauma remain the strongest associations. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III; Therapeutic study, level IV.
AB - BACKGROUND The rarity of renal trauma limits its study and the strength of evidence-based guidelines. Although management of renal injuries has shifted toward a nonoperative approach, nephrectomy remains the most common intervention for high-grade renal trauma (HGRT). We aimed to describe the contemporary management of HGRT in the United States and also evaluate clinical factors associated with nephrectomy after HGRT. METHODS From 2014 to 2017, data on HGRT (American Association for the Surgery of Trauma grades III-V) were collected from 14 participating Level-1 trauma centers. Data were gathered on demographics, injury characteristics, management, and short-term outcomes. Management was classified into three groups-expectant, conservative/minimally invasive, and open operative. Descriptive statistics were used to report management of renal trauma. Univariate and multivariate logistic mixed effect models with clustering by facility were used to look at associations between proposed risk factors and nephrectomy. RESULTS A total of 431 adult HGRT were recorded; 79% were male, and mechanism of injury was blunt in 71%. Injuries were graded as III, IV, and V in 236 (55%), 142 (33%), and 53 (12%), respectively. Laparotomy was performed in 169 (39%) patients. Overall, 300 (70%) patients were managed expectantly and 47 (11%) underwent conservative/minimally invasive management. Eighty-four (19%) underwent renal-related open operative management with 55 (67%) of them undergoing nephrectomy. Nephrectomy rates were 15% and 62% for grades IV and V, respectively. Penetrating injuries had significantly higher American Association for the Surgery of Trauma grades and higher rates of nephrectomy. In multivariable analysis, only renal injury grade and penetrating mechanism of injury were significantly associated with undergoing nephrectomy. CONCLUSION Expectant and conservative management is currently utilized in 80% of HGRT; however, the rate of nephrectomy remains high. Clinical factors, such as surrogates of hemodynamic instability and metabolic acidosis, are associated with nephrectomy for HGRT; however, higher renal injury grade and penetrating trauma remain the strongest associations. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III; Therapeutic study, level IV.
KW - Renal trauma
KW - multicenter study
KW - renal injury grading
KW - trauma centers
KW - wounds and injuries
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U2 - 10.1097/TA.0000000000001796
DO - 10.1097/TA.0000000000001796
M3 - Article
C2 - 29298242
AN - SCOPUS:85042914491
SN - 2163-0755
VL - 84
SP - 418
EP - 425
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 3
ER -