High grade renal trauma: Does the mechanism of penetrating injury influence renal salvage rate?

Published on Aug 18, 2021in Injury-international Journal of The Care of The Injured2.106
· DOI :10.1016/J.INJURY.2021.08.016
Willem Meyer du Plessis (UKZN: University of KwaZulu-Natal), Danelo du Plessis (Stellenbosch University)+ 2 AuthorsDamian L. Clarke22
Estimated H-index: 22
(University of the Witwatersrand)
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Abstract
Abstract null null Background null Most of the data on high grade Traumatic renal injuries (TRI) has come from centres which predominantly encounter blunt trauma. Blunt and penetrating mechanisms are not analogous, and it is imprudent to blindly extrapolate management strategies between the two groups. In addition, within the broad group of penetrating mechanisms of injury there are also major differences between gunshot wounds (GSW) and stab wounds (SW). The aim of this comparative study of GSW and SW to the kidney is to quantify the impact of the mechanism of injury on nephrectomy rate in high grade TRI. null null null Methods null A prospective trauma registry was interrogated retrospectively. All patients sustaining a high grade (Grade III to V) penetrating TRI were included. The diagnosis was made either with cross-sectional imaging or intra-operative findings. The nephrectomy rate of the different mechanisms of penetrating (GSW vs SW) TRI was compared in each grade. null null null Results null A total of 28 GSW and 27 SW causing high grade TRIs (Grade III-V) were included over the 85 months of the study. GSW lead to a higher nephrectomy rate than SWs 50.0 vs 19%, (p = 0.023). When comparing grade for grade, Grade III: 20.0 (GSW) vs 21% (SW), (p = 1). Grade IV: 71 (GSW) vs 17%, (SW) (p = 0.058) and Grade V: 100 (GSW) vs 0%, (SW) (p = 0.28). When comparing Grade IV – V together, the difference is 85 (GSW) vs 15%, (SW) (p = 0.001). null null null Conclusion null On a grade to grade comparison GSWs have a much higher risk for nephrectomy than SW's in grade IV and V TRI. TRI secondary to GSWs appears to be an independent risk factor for nephrectomy in high grade injuries. The mechanism of penetrating TRI should be considered in future management algorithms and clinical approaches.
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#1M.S. Salem (UKZN: University of KwaZulu-Natal)H-Index: 1
#2R.J. Urry (Sefako Makgatho Health Sciences University)H-Index: 1
Last. Grant L. Laing (UKZN: University of KwaZulu-Natal)H-Index: 12
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Abstract Background This study is intended to assess the current optimal management of traumatic renal injuries (TRIs), with a focus on high-grade and penetrating injuries. Methods The Pietermaritzburg Metropolitan Trauma Service registry was interrogated retrospectively for patients managed for TRI between 1 January 2012 and 31 December 2016. Results Of 13,315 inured patients treated by the PMTS, 223 (1.7%) had TRIs with an incidence of 1.5 per 100,000 population per year. The majority were mal...
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#1Rosemary A. Kozar (UF: University of Florida)H-Index: 2
#2Marie Crandall (UMB: University of Maryland, Baltimore)H-Index: 28
Last. Gail T. Tominaga (Memorial Hospital of South Bend)H-Index: 23
view all 9 authors...
In 1989, Moore et al. on behalf of the American Association for the Surgery of Trauma (AAST) published the Organ Injury Scale (OIS) for spleen, liver, and kidney.1 This was then updated for spleen and liver in 1994.2 These initial classification schemes were based on an anatomic description of the i
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#1Will Fischer (IU: Indiana University)H-Index: 27
#2Anne Wanaselja (IUPUI: Indiana University – Purdue University Indianapolis)H-Index: 1
Last. Scott D. SteenburgH-Index: 13
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OBJECTIVE. The purpose of this article is to calculate the incidence of urinary leak, at both admission and delayed presentation, in the setting of blunt or penetrating renal trauma, and to determine the diagnostic yield of 5-minute excretory phase images on admission CT. MATERIALS AND METHODS. Renal injuries were retrospectively identified from the trauma registry at an urban level I trauma center over a 6-year period. Follow-up imaging and clinical and surgical notes were reviewed and served a...
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#1Steve P. McCombie (UWA: University of Western Australia)H-Index: 4
#2Isaac Thyer (Fremantle Hospital)H-Index: 3
Last. Dickon Hayne (UWA: University of Western Australia)H-Index: 18
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Objective To review the literature and make practical recommendations regarding the conservative management of renal trauma. Patients and Methods Relevant articles and guidelines published between 1980 and 2014 were reviewed. Graded recommendations were constructed by a multi-disciplinary panel consisting of urologists, radiologists, and infectious disease physicians. These recommendations underwent formal review and debate at the Western Australian USANZ 2013 state conference, and were presente...
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#1Grant L. Laing (UKZN: University of KwaZulu-Natal)H-Index: 12
#2John L. Bruce (UKZN: University of KwaZulu-Natal)H-Index: 13
Last. Damian L. Clarke (UKZN: University of KwaZulu-Natal)H-Index: 22
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Abstract Introduction The Pietermaritzburg Metropolitan Trauma Service formerly lacked a robust computerised trauma registry. This made surgical audit difficult for the purpose of quality of care improvement and development. We aimed to design, construct and implement a computerised trauma registry within our service. Twelve months following its implementation, we sought to examine and report on the quality of the registry. Methodology Formal ethical approval to maintain a computerised trauma re...
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Objective: To analyze our experiences in patients with traumatic retroperitoneal hematoma, and highlight the problems in diagnosis and treatment to facilitate the surgeons to make decision. Methodology: One hundred and eight patients of traumatic retroperitoneal hematoma treated in our institution from May 2008 to Jun 2012 were reviewed retrospectively. The data including patient’s age, type of injury, hospital stays, type of treatment, injured organs and mortality rate were collected. Results: ...
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#1Conray Moolman (UCT: University of Cape Town)H-Index: 2
#2Pradeep H. Navsaria (UCT: University of Cape Town)H-Index: 34
Last. A. Pontin (UCT: University of Cape Town)H-Index: 1
view all 5 authors...
Purpose: The role of nonoperative management for penetrating kidney injuries is unknown. Therefore, we review the management and outcome of penetrating kidney injuries at a center with a high incidence of penetrating trauma.Materials and Methods: Data from all patients presenting with hematuria and/or kidney injury discovered on imaging or at surgery admitted to the trauma center at Groote Schuur Hospital in Cape Town, South Africa during a 19-month period (January 2007 to July 2008) were prospe...
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#1Marc A. BjurlinH-Index: 26
#2Eric I. Jeng (UIC: University of Illinois at Chicago)H-Index: 5
Last. Gary J. MerlottiH-Index: 11
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BACKGROUND: We reviewed our experience with penetrating renal injuries to compare nonoperative management of penetrating renal injuries with renorrhaphy and nephrectomy in light of concerns for unnecessary explorations and increased nephrectomy rates. METHODS: In this retrospective study, we reviewed the records of 98 penetrating renal injuries from 2003 to 2008. Renal injuries were classified according to the American Association for the Surgery of Trauma and analyzed based on nephrectomy, reno...
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#2Niall M. CorcoranH-Index: 33
Last. Matthew BultitudeH-Index: 17
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In the management of renal trauma, surgical exploration inevitably leads to nephrectomy in all but a few specialized centers. With current management options, the majority of hemodynamically stable patients with renal injuries can be successfully managed nonoperatively. Improved radiographic techniques and the development of a validated renal injury scoring system have led to improved staging of injury severity that is relatively easy to monitor. This article reviews a multidisciplinary approach...
#1Philipp Lichte (RWTH Aachen University)H-Index: 14
#2Reiner OberbeckH-Index: 17
Last. Philipp Kobbe (RWTH Aachen University)H-Index: 25
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Background Gun violence is on the rise in some European countries, however most of the literature on gunshot injuries pertains to military weaponry and is difficult to apply to civilians, due to dissimilarities in wound contamination and wounding potential of firearms and ammunition. Gunshot injuries in civilians have more focal injury patterns and should be considered distinct entities.
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