Faculty Collaboration Database

Grade V renal trauma management: results from the multi-institutional genito-urinary trauma study. World J Urol 2023 Jul;41(7):1983-1989

Date

06/25/2023

Pubmed ID

37356027

DOI

10.1007/s00345-023-04432-w

Scopus ID

2-s2.0-85162963162 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

PURPOSE: To investigate management trends for American Association for the Surgery of Trauma (AAST) grade V renal trauma with focus on non-operative management.

METHODS: We used prospectively collected data as part of the Multi-institutional Genito-Urinary Trauma Study (MiGUTS). We included patients with grade V renal trauma according to the AAST Injury Scoring Scale 2018 update. All cases submitted by participating centers with radiology images available were independently reviewed to confirm renal trauma grade. Management was classified as expectant, conservative (minimally invasive, endoscopic or percutaneous procedures), or operative (renal-related surgery).

RESULTS: Eighty patients were included, 25 of whom had complete imaging and had independent confirmation of AAST grade V renal trauma. Median age was 35 years (Interquartile range (IQR) 25-50) and 23 (92%) had blunt trauma. Ten patients (40%) were managed operatively with nephrectomy. Conservative management was used in nine patients (36%) of which six received angioembolization and three had a stent or drainage tube placed. Expectant management was followed in six (24%) patients. Transfusion requirements were progressively higher with groups requiring more aggressive treatment, and injury characteristics differed significantly across management groups in terms of hematoma size and laceration size. Vascular contrast extravasation was more likely in operatively managed patients though a statistically significant association was not found.

CONCLUSION: Successful use of nonoperative management for grade V injuries is used for a substantial subset of patients. Lower transfusion requirement and less severe injury radiologic phenotype appear to be important characteristics delineating this group.

Author List

Hakam N, Keihani S, Shaw NM, Abbasi B, Jones CP, Rogers D, Wang SS, Gross JA, Joyce RP, Hagedorn JC, Selph JP, Sensenig RL, Moses RA, Dodgion CM, Gupta S, Mukherjee K, Majercik S, Smith BP, Broghammer JA, Schwartz I, Baradaran N, Zakaluzny SA, Erickson BA, Miller BD, Askari R, Carrick MM, Burks FN, Norwood S, Myers JB, Breyer BN, Multi-institutional Genito-Urinary Trauma Study Group (MiGUTS)

Author

Christopher M. Dodgion MD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Humans
Injury Severity Score
Kidney
Middle Aged
Multiple Trauma
Nephrectomy
Retrospective Studies
Trauma Centers
Urogenital System