J Korean Soc Traumatol.  2017 Dec;30(4):192-196. 10.20408/jti.2017.30.4..

Management of High-grade Blunt Renal Trauma

Affiliations
  • 1Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea.

Abstract

PURPOSE
Blunt injury accounts for 80-95% of renal injury trauma in the United States. The majority of blunt renal injuries are low grade and 80-85% of these injuries can be managed conservatively. However, there is a debate on the management of patients with high-grade renal injury. We reviewed our experience of renal trauma at our trauma center to assess management strategy for high-grade blunt renal injury.
METHODS
We reviewed blunt renal injury cases admitted at a single trauma center between August 2007 and December 2015. Computed tomography (CT) scan was used to diagnose renal injuries and high-grade (according to the American Association for the Surgery of Trauma [AAST] organ injury scale III-V) renal injury patients were included in the analysis.
RESULTS
During the eight-year study period, there were 62 AAST grade III-V patients. 5 cases underwent nephrectomy and 57 underwent non-operative management (NOM). There was no difference in outcome between the operative group and the NOM group. In the NOM group, 24 cases underwent angioembolization with a 91% success rate. The Incidence of urological complications correlated with increasing grade.
CONCLUSIONS
Conservative management of high-grade blunt renal injury was considered preferable to operative management, with an increased renal salvage rate. However, high-grade injuries have higher complication rates, and therefore, close observation is recommended after conservative management.

Keyword

Trauma; Kidney injury; Therapeutic embolization; Conservative treatment

MeSH Terms

Embolization, Therapeutic
Humans
Incidence
Nephrectomy
Trauma Centers
United States
Wounds, Nonpenetrating
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