Abstract
BackgroundThere is no consensus on the role of routine follow-up imaging during nonoperative management of blunt renal trauma. We reviewed our experience with nonoperative management of blunt renal injuries in order to evaluate the utility of routine early follow-up imaging.MethodsWe reviewed all cases of blunt renal injury admitted for nonoperative management at our institution between 1/2002 and 1/2006. Data were compiled from chart review, and clinical outcomes were correlated with CT imaging results.Results207 patients were identified (210 renal units). American Association for the Surgery of Trauma (AAST) grades I, II, III, IV, and V were assigned to 35 (16%), 66 (31%), 81 (39%), 26 (13%), and 2 (1%) renal units, respectively. 177 (84%) renal units underwent routine follow-up imaging 24–48 hours after admission. In three cases of grade IV renal injury, a ureteral stent was placed after serial imaging demonstrated persistent extravasation. In no other cases did follow-up imaging independently alter clinical management. There were no urologic complications among cases for which follow-up imaging was not obtained.ConclusionRoutine follow-up imaging is unnecessary for blunt renal injuries of grades I-III. Grade IV renovascular injuries can be followed clinically without routine early follow-up imaging, but urine extravasation necessitates serial imaging to guide management decisions. The volume of grade V renal injuries in this study is not sufficient to support or contest the need for routine follow-up imaging.
Highlights
There is no consensus on the role of routine follow-up imaging during nonoperative management of blunt renal trauma
We reviewed our contemporary experience with nonoperative management of blunt renal injuries in order to reassess the utility of routine early follow-up imaging
Injuries were graded by a staff radiologist according to the American Association for the Surgery of Trauma (AAST) organ injury scale [5]
Summary
There is no consensus on the role of routine follow-up imaging during nonoperative management of blunt renal trauma. We reviewed our experience with nonoperative management of blunt renal injuries in order to evaluate the utility of routine early follow-up imaging. Nonoperative management has become the rule for the majority of blunt renal injuries, with higher rates of renal salvage and decreased morbidity compared to primary surgical management [1]. Our center has previously advocated routine follow-up imaging 2 to 4 days after blunt renal trauma to identify patients that may require intervention for delayed complications [2]. We reviewed our contemporary experience with nonoperative management of blunt renal injuries in order to reassess the utility of routine early follow-up imaging
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