230 HIGH GRADE RENAL INJURIES: APPLICATION OF PARKLAND HOSPITAL'S PREDICTORS OF INTERVENTION FOR RENAL BLEEDING TO A LARGE SERIES OF PATIENTS WITH BLUNT RENAL TRAUMA

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery III1 Apr 2012230 HIGH GRADE RENAL INJURIES: APPLICATION OF PARKLAND HOSPITAL'S PREDICTORS OF INTERVENTION FOR RENAL BLEEDING TO A LARGE SERIES OF PATIENTS WITH BLUNT RENAL TRAUMA Miranda Hardee, MD Mark Stevens, MD Raminder Nirula, MD William Lowrance, MD William Brant, MD Scott Gardner, Bryce Leishman, and Jeremy MyersMD Miranda HardeeMiranda Hardee Salt Lake City, UT More articles by this author , Mark StevensMark Stevens Murray, UT More articles by this author , Raminder NirulaRaminder Nirula Salt Lake City, UT More articles by this author , William LowranceWilliam Lowrance Salt Lake City, UT More articles by this author , William BrantWilliam Brant Salt Lake City, UT More articles by this author , Scott GardnerScott Gardner Murray, UT More articles by this author , Bryce LeishmanBryce Leishman Salt Lake City, UT More articles by this author , and Jeremy MyersJeremy Myers Salt Lake City, UT More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.285AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Currently, the American Association Surgery of Trauma (AAST) grading scale remains the standard for assessment of renal injury. Researchers from Parkland Hospital have proposed further substratification of AAST grading based on the presence of active vascular extravasation, medial laceration, and a perinephric hematoma > 3.5cm to better guide management of these injuries. The purpose of this study was to evaluate high-grade renal injuries using these characteristics to determine if they serve as reliable predictors for intervention for renal bleeding in blunt trauma. METHODS We conducted a retrospective review of renal trauma from 2005 to 2011 at all level 1 adult trauma centers in Utah. In patients with AAST grade 3-5 injuries, injuries were further characterized according to the presence of active bleeding, medial located laceration, and the presence of a perinephric hematoma > 3.5cm. One point was assigned for each of these risk factors. Our primary outcome was the need for an invasive intervention to control renal bleeding (selective embolization or renal exploration). We used simple logistic regression to evaluate the impact of each of the 3 risk factors on the primary outcome. RESULTS We identified 147 high-grade injuries. We excluded patients with penetrating trauma, those taken emergently for exploration without imaging, and bilateral renal injuries. Of the 120 patients meeting inclusion criteria, there were 62 (52%) grade 3, 41 (34%) grade 4, and 16 (13%) grade 5 renal injuries. For renal bleeding, 8 (7%) patients underwent intervention. The presence of active vascular extravasation (p-value=0.001) and a perinephric hematoma of > 3.5cm (p-value=0.006) were predictive of need for intervention, while having a medial laceration was not (p-value=0.175). Patients with 1 or less risk factors had a 2% need for intervention, whereas 30% of patients with 2 or more risk factors required intervention. CONCLUSIONS Unlike previous studies, we found only vascular extravasation and the presence of a perinephric hematoma >3.5cm to be predictive of intervention for bleeding. Our study is limited by the small number of interventions and the numerous patients that underwent operative exploration without pre-operative imaging. However, we did find patients with 2 or more risk factors to be at increased risk for bleeding. These imaging features have potential to serve as useful prognostic indicators in assessing renal trauma, and should be applied to a larger multi-institutional population for evaluation. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e95 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Miranda Hardee Salt Lake City, UT More articles by this author Mark Stevens Murray, UT More articles by this author Raminder Nirula Salt Lake City, UT More articles by this author William Lowrance Salt Lake City, UT More articles by this author William Brant Salt Lake City, UT More articles by this author Scott Gardner Murray, UT More articles by this author Bryce Leishman Salt Lake City, UT More articles by this author Jeremy Myers Salt Lake City, UT More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...