MP18-02 FACTORS PREDICTING THE OUTCOME OF NON-OPERATIVE MANAGEMENT OF HIGH GRADE BLUNT RENAL TRAUMA

Abstract Background Recently, renal angioembolization (RAE) has gained an important role in the non-operative management (NOM) of moderate to high-grade blunt renal injuries (BRI), but its use remains heterogeneous. The aim of this review is to examine the current literature on indications and outcomes of angioembolization in BRI. Methods We conducted a search of MEDLINE, EMBASE, SCOPUS and Web of Science Databases up to February 2021 in accordance with PRISMA guidelines for studies on BRI treated with RAE. The methodological quality of eligible studies and their risk of bias was assessed using the Newcastle–Ottawa scale Results A total of 16 articles that investigated angioembolization of blunt renal injury were included in the study. Overall, 412 patients were included: 8 presented with grade II renal trauma (2%), 97 with grade III renal trauma (23%); 225 with grade IV (55%); and 82 with grade V (20%). RAE was successful in 92% of grade III–IV (294/322) and 76% of grade V (63/82). Regarding haemodynamic status, success rate was achieved in 90% (312/346) of stable patients, but only in 63% (42/66) of unstable patients. The most common indication for RAE was active contrast extravasation in hemodynamic stable patients with grade III or IV BRI. Conclusions This is the first review assessing outcomes and indication of angioembolization in blunt renal injuries. The results suggest that outcomes are excellent in hemodynamic stable, moderate to high-grade renal trauma.

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

African Journal of Urology ◽

10.1016/j.afju.2014.11.006 ◽

2015 ◽

Vol 21 (1) ◽

pp. 44-51 ◽

Cited By ~ 7

Author(s):

A.M. Maarouf ◽

A-F. Ahmed ◽

E. Shalaby ◽

Y. Badran ◽

E. Salem ◽

...

Keyword(s):

Operative Management ◽

Renal Trauma ◽

High Grade ◽

Non Operative Management

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The management and outcome of paediatric splenic injuries in the Netherlands

World Journal of Emergency Surgery ◽

10.1186/s13017-021-00353-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Maike Grootenhaar ◽

Dominique Lamers ◽

Karin Kamphuis-van Ulzen ◽

Ivo de Blaauw ◽

Edward C. Tan

Keyword(s):

The Netherlands ◽

Hospital Stay ◽

Operative Management ◽

Trauma Centre ◽

Management Approach ◽

Haemodynamic Instability ◽

Low Grade ◽

High Grade ◽

Level 1 ◽

Non Operative Management

Abstract Background Non-operative management (NOM) is generally accepted as a treatment method of traumatic paediatric splenic rupture. However, considerable variations in management exist. This study analyses local trends in aetiology and management of paediatric splenic injuries and evaluates the implementation of the guidelines proposed by the American Paediatric Surgical Association (APSA) in a level 1 trauma centre. Methods The charts of paediatric patients with blunt splenic injury (BSI) who were admitted or transferred to a level 1 trauma centre between 2003 and 2020 were retrospectively assessed. Information pertaining to demographics, mechanism of injury, injury description, associated injuries, intervention and outcomes were analysed and compared to international literature. Results There were 130 patients with BSI identified (63.1% male), with a mean age of 11.3 ± 4.0 and a mean Injury Severity Score (ISS) of 21.6 ± 13.7. Bicycle accidents were the most common trauma mechanism (23.1%). Sixty-four percent were multi-trauma patients, 25% received blood transfusions, and 31% were haemodynamically unstable. Mean injury grade was 3.0, with 30% of patients having a high-grade injury. In total, 75% of patients underwent NOM with a 100% efficacy rate. Total splenectomy rate was 6.2%. Four patients died due to brain damage. Patients with a high-grade BSI (grades IV–V) had a significantly higher ISS and longer bedrest and more often presented with an active blush on computed tomography (CT) scans than patients with a low-grade BSI (grades I–III). Non-operative management was mainly the choice of treatment in both groups (76.6% and 79.5%, respectively). Haemodynamic instability was a predictor for operative management (OM) (p = 0.001). Predictors for a longer length of stay (LOS) included concomitant injuries, haemodynamic instability and OM (all p < 0.02). Interobserver agreement in the grading of BSI is moderate, with a Cohens Kappa coefficient of 0.493. Conclusion Non-operative management has proven to be a realistic management approach in both low- and high-grade splenic injuries. Consideration for operative management should be based on haemodynamic instability. Compared to the anticipated length of bedrest and hospital stay outlined in the APSA guidelines, the Netherlands can reduce the length of bedrest and hospital stay through their non-operative management. Level of evidence Therapeutic study, level III

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Early Characteristics and Progression of Blunt Traumatic Aortic Injuries at a Single Level I Trauma Center

Vascular and Endovascular Surgery ◽

10.1177/1538574420966450 ◽

2020 ◽

pp. 153857442096645

Author(s):

Daniel Cheng ◽

Allison G. McNickle ◽

Douglas R. Fraser ◽

Joseph T. Carroll ◽

Jorge A. Vega ◽

...

Keyword(s):

Motor Vehicle ◽

Traumatic Injury ◽

Operative Management ◽

Aortic Injury ◽

Low Grade ◽

High Grade ◽

Aortic Pathology ◽

Non Operative Management ◽

Delayed Intervention ◽

Repeat Imaging

Objectives: The most widely accepted grading system for blunt traumatic aortic injury (BTAI) by the Society of Vascular Surgery (SVS) recommends endovascular repair for grade 2 and greater. Non-operative management in grade 2 injuries has been shown to be reasonable in certain circumstances. The natural history of low-grade injuries (1, 2) when managed non-operatively is not well defined. Methods: Utilizing our trauma registry, patients from 2013 to 2016 with blunt traumatic injury who underwent initial computed tomography were identified. Aortic pathology was graded and grouped by SVS classification. Clinical courses were reviewed for timing of interventions, repeat imaging, concurrent injuries, and outcomes. Analysis of variance and Chi-square tests of significance were utilized to compare between groups. Results: Out of 10,178 patients, we identified 32 with BTAI (grade: 1 (n = 13), 2 (n = 5), 3 (n = 3), 4 (n = 11)). High-grade injuries (3, 4) resulted only from motor vehicle, motorcycle, and pedestrian mechanisms. Initially, 9 patients (28%) required intervention, 5 (16%) were treated non-operatively, and 18 (56%) underwent repeat imaging. On repeat imaging, injuries that did not resolve remained stable and no injuries were found to progress. Of these patients, 9 (50%) required delayed intervention and 9 (50%) successfully underwent non-operative management. Patients with low-grade injuries were more likely to have successful non-operative management than those with high-grade injuries (72% vs 7%; p < 0.01). Conclusions: While low-grade injuries generally have good outcomes, some ultimately do require delayed intervention, and short-term imaging is not reliable in identifying these cases.

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Non-Operative Management for Renal and Splenic Trauma – A Case Report

BULLETIN OF THE TRANSILVANIA UNIVERSITY OF BRASOV SERIES VI - MEDICAL SCIENCES ◽

10.31926/but.ms.2020.62.13.2.6 ◽

2020 ◽

Vol 13 (62) (2) ◽

pp. 43-52

Author(s):

Alexandru Georgian Lăculiceanu ◽

Denis Anamaria Mereț ◽

Ruxandra Rotaru ◽

Mircea Daniel Hogea ◽

Ioan Scârneciu

Keyword(s):

Injury Severity ◽

Left Kidney ◽

Operative Management ◽

Renal Trauma ◽

Iliopsoas Muscle ◽

Splenic Trauma ◽

Trauma Patients ◽

Packed Red Blood Cells ◽

Grade Ii ◽

Non Operative Management

Management of abdominal trauma has evolved over the past decades and most of trauma patients can be managed conservatively. This article demonstrates the effectiveness of non-operative management (NOM) in a patient with grade IV renal trauma and grade II splenic trauma that was treated in the urology department of Emergency Clinical County Hospital of Brasov after a car crash. Clinical examination showed bruises on the right shoulder and macroscopic haematuria that suggest renal trauma. The abdomen was spontaneously painles, no signs of acute abdomen but severe pain in the left lumbar area, with no additional relevant medical history. The CT scan revealed laceration of the valvular area of the left kidney, spleen contusion and retroperitoneal haematoma with contrast spreading in the iliopsoas muscle region, classifying renal trauma as stage IV and splenic trauma as stage II on American Association for the Surgery of Trauma injury scale. The trauma is classified as serious with an Injury Severity Score of 18, and Resciniti CT score of 2, therefore NOM is recommended. Despite high grade trauma, the patient was haemodynamically stable, with a heart rate of 90 bpm, blood pressure of 105/65 mmHg and haemoglobin of 10.4g/dl. Under constant observation and with the help of a multidisciplinary team, the therapeutic focus was directed on local protocol consisting of pharmacological treatment with fluid resuscitation, antibiotic therapy, analgesics, haemostatics, anticoagulant therapy and multiple blood transfusions consisting of fresh frozen plasma and packed red blood cells. Starting with day 6, the haemoglobin levels normalized, no further blood transfusion beeing necessary. The patient was discharged and didn’t developed complications in the following 6 months. The NOM in the case of grade IV renal trauma and a grade II splenic trauma is effective, provided the patients are haemodynamically stable and constant reevaluations are performed.

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Non-Operative Management with Angioembolization of Grade IV and V Renal Injuries in a Hybrid Emergency Room System

Journal of Trauma and Injury ◽

10.20408/jti.2021.0034 ◽

2021 ◽

Vol 34 (3) ◽

pp. 191-197

Author(s):

So Ra Ahn ◽

Sang Hyun Seo ◽

Joo Hyun Lee ◽

Chan Yong Park

Keyword(s):

Emergency Room ◽

Trauma Center ◽

Arterial Embolization ◽

Operative Management ◽

University Hospital ◽

Percutaneous Catheter Drainage ◽

High Grade ◽

Kidney Preservation ◽

Non Operative Management ◽

Renal Injuries

Renal injuries occur in more than 10% of patients who sustain blunt abdominal injuries. Non-operative management (NOM) is the established treatment strategy for lowgrade (I–III) renal injuries. However, despite some evidence that NOM can be successfully applied to high-grade (IV, V) renal injuries, it remains unclear whether NOM is appropriate in such cases. The authors report two cases of high-grade renal injuries that underwent NOM after embolization in a hybrid emergency room (ER) system with a 24/7 in-house interventional radiology (IR) team. A 29-year-old male visited Wonkwang University Hospital Regional Trauma Center complaining of right abdominal pain after being hit by a rope. Computed tomography (CT) was performed 16 minutes after arrival, and the CT scan indicated a grade V right renal injury. Arterial embolization was initiated within 31 minutes of presentation. A 56-year-old male was transferred to Wonkwang University Hospital Regional Trauma Center with a complaint of right flank pain. He had initially presented to a nearby hospital after falling from a 3-m height. Thanks to the key CT images sent from the previous hospital prior to the patient’s arrival, angiography was performed within 8 minutes of the patient’s arrival and arterial embolization was completed within 25 minutes. Both patients were treated successfully through NOM with angioembolization and preserved kidneys. Hematoma in the first patient and urinoma in the second patient resolved with percutaneous catheter drainage. The authors believe that the hybrid ER system with an in-house IR team could contribute to NOM and kidney preservation even in high-grade renal injuries.

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E-scooter accidents: A rising cause of kidney injury

Urologia Journal ◽

10.1177/03915603211037611 ◽

2021 ◽

pp. 039156032110376

Author(s):

Alberto Bianchi ◽

Sebastian Gallina ◽

Francesco Cianflone ◽

Alessandro Tafuri ◽

Maria Angela Cerruto ◽

...

Keyword(s):

Fluid Layer ◽

Kidney Injury ◽

Operative Management ◽

High Grade ◽

Abdominal Ct ◽

Perirenal Hematoma ◽

First Case ◽

Kidney Trauma ◽

Kidney Involvement ◽

Non Operative Management

Introduction: E-scooters recently gained mass expansion, leading to increased use-related injuries, most commonly head trauma, facial, and extremity fractures, while abdominal trauma with kidney involvement is less frequent. Here we present two cases of e-scooter-related high-grade blunt kidney trauma. Case reports: The first case was a 24-year-old male presenting with right abdominal pain after e-scooter autonomous right fall. Focused assessment with sonography for trauma (FAST) was negative, while abdominal CT showed a 3 cm middle-renal laceration. Six-day CT showed minimal urinary extravasation. Neither anemization nor impaired kidney function was observed; the patient was discharged after 9 days. The second case was a 42-year-old male presenting with right flank pain and ipsilateral chest pain after autonomous right fall. Thoracic X-ray revealed multiple rib fractures, while abdominal echography showed a non-homogeneous right kidney with a 1.5 cm perirenal fluid layer. Abdominal CT revealed 2.5 × 4 × 3.5 cm full-thickness middle-upper renal parenchyma laceration and confirmed the perirenal hematoma, while demonstrating two hepatic lesions. A series of CT and ultrasounds confirmed the stability of the aforementioned lesions and reduction of the perirenal hematoma; laboratory findings didn’t show anemization nor impaired renal function. The patient was discharged after 10 days. Discussion: Widespread usage of e-scooter is accompanied by an uptick in traumatic events. The chance of renal trauma increases when lateral fall occurs. In our cases patients were hemodynamically stable, the kidney injury severity was high-grade, and non-operative management was effective. Conclusion: E-scooter accidents could lead to high-grade renal injuries, amenable of non-operative management; these events are expected to raise.

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