MP20-04 GRADE V RENAL TRAUMA: SUCCESS ROLE FOR CONSERVATIVE MANAGEMENT IN THE NATIONAL TRAUMA DATABANK

Abstract

You have accessJournal of UrologyCME1 May 2022MP20-04 GRADE V RENAL TRAUMA: SUCCESS ROLE FOR CONSERVATIVE MANAGEMENT IN THE NATIONAL TRAUMA DATABANK Nizar Hakam, Nathan Shaw, Jason Lui, Behnam Nabavizadeh, Kevin Li, Patrick Low, and Benjamin Breyer Nizar HakamNizar Hakam More articles by this author , Nathan ShawNathan Shaw More articles by this author , Jason LuiJason Lui More articles by this author , Behnam NabavizadehBehnam Nabavizadeh More articles by this author , Kevin LiKevin Li More articles by this author , Patrick LowPatrick Low More articles by this author , and Benjamin BreyerBenjamin Breyer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002553.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Conservative management is now standard for most renal trauma as it decreases complications and nephrectomy rates. However, American Association for the Surgery of Trauma (AAST) grade V injuries renal injuries continue to largely require intervention and sparse data is available on conservative management. We investigate whether conservative management was pursued in patients who survive grade V renal injuries using the National Trauma Databank (NTDB). METHODS: Patients with grade V renal trauma were identified in the 2018 NTDB (n=612). Patients who survived to final hospital discharge were included (n=474). Conservative management was defined by the absence of any surgical or procedural intervention. Percutaneous or cystoscopic drain placement was exempted from procedural intervention. Characteristics of patients who underwent conservative vs non-conservative management were compared. RESULTS: Out of 474 patients, 175 (36.9%) were managed conservatively. In the 299 patients managed non-conservatively, most common interventions were surgical exploration (n=200, 66.9%), nephrectomy (n=196, 65.6%), kidney angioembolization (n=60, 20.1%), open surgical bleeding control (n=37, 12.4%), and surgical repair of the kidney or renal artery (n=22, 7.4%). Patient characteristics are depicted in Table 1, stratified by management approach. Patients managed conservatively had more favorable hemodynamic parameters compared to those managed non-conservatively, exhibiting lower mean pulse rate (99.9 vs 106.2, p=0.01). They had less hypotension on arrival (8.6% vs 17.4%, p=0.008) and received fewer blood transfusion (28% vs 67.2%, p<0.001). They also were younger (mean age 26.7 vs 30.5, p=0.01), less likely to be male (71.4% vs 91.6%, p=0.01), less likely to have sustained a penetrating injury (6.7% vs 51.2%, p <0.001), and had a significantly different distribution of trauma mechanism (Table 1). CONCLUSIONS: A conservative approach may be safe in a subset of patients with grade V renal injury, especially in those who were less likely to be in shock, receive blood transfusion, or sustain penetrating injury. Further research to identify phenotypes amenable to conservative management is warranted to improve patient outcomes. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e318 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nizar Hakam More articles by this author Nathan Shaw More articles by this author Jason Lui More articles by this author Behnam Nabavizadeh More articles by this author Kevin Li More articles by this author Patrick Low More articles by this author Benjamin Breyer More articles by this author Expand All Advertisement PDF DownloadLoading ...