The aim of this study was to describe the management of severe blunt renal injuries at a Level I trauma hospital. Data were collected through a record review of patients admitted from January 1, 2000, to December 31, 2011. These data were compiled as part of our hospital's participation in the Nonoperative Management of Grade IV and V Blunt Renal Injuries: A Research Consortium of New England Centers for Trauma Study. Thirty-six patients with severe blunt renal injuries were identified. Twenty-nine (80.6%) underwent nonoperative management (NOM) for their injuries. Seven (19.4%) received an immediate operation because of hemodynamic instability or CT findings of large hemoperitoneum or extravasation. No significant differences were observed on Injury Severity Score, Glasgow Coma Scale, injury grade, or systolic blood pressure on arrival to the emergency department. On arrival, the operative patients had higher heart rates and lower hematocrit and hemoglobin values relative to the NOM patients. The kidney was salvaged in three of the seven operative patients and was either saved or partially saved in all except one NOM patient. Three NOM patients died; none because of renal injuries. All other patients were successfully managed. None of the operative patients died. NOM management of high-grade renal injury was successful for these patients and should be considered in the management of grade IV and V blunt renal trauma.
Successful Nonoperative Management of the Most Severe Blunt Renal Injuries
