Factors predicting the outcome of non-operative management of high-grade blunt renal trauma

Abstract

Objectives: In this retrospective study we reviewed the outcome of non-operative management of high-grade blunt renal injuries (grade III–V) and evaluated the predictive indicators of management failure.

Subjects and methods: The data review included the patients’ demographics, the mechanism of trauma and the clinical characteristics, as well as the laboratory and imaging data upon admission and at follow-up. The data of the patients who were successfully managed non-operatively and of those who needed intervention for renal injuries were compared.

Results: Two hundred and six patients were enrolled in this study. Grade III, grade IV and grade V renal injuries were found in 39.8%, 44.2% and 16% of the patients, respectively. The overall success rate of non-operative management was 87.9%, including all patients with grade III, 86.8% of patients with grade IV and 60.6% of those with grade V injuries. Multivariate analysis revealed that trauma secondary to motor vehicle accident, hypotension at presentation, associated injuries to other organs, grade V renal injury and computed tomography (CT) imaging features, namely medial renal parenchymal laceration, perirenal hematoma ≥3.5 cm and intravascular extravasation were significant predictors for failure of non-operative management.

Conclusion: Our findings suggest that high-grade renal injuries in hemodynamically stable patients can be managed conservatively with a high success rate. Multiple clinical and radiological variables can predict the treatment outcome.

Keywords: High grade; Non-operative management; Outcome; Renal trauma