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Traumatic renal injury in a UK major trauma centre – current management strategies and the role of early re-imaging

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Title: Traumatic renal injury in a UK major trauma centre – current management strategies and the role of early re-imaging
Authors: Aldiwani, M
Georgiades, F
Omar, I
Angel-Scott, H
Tharakan, T
Vale, J
Mayer, E
Item Type: Journal Article
Abstract: Objectives To analyse the contemporary management of renal injuries in a UK major trauma centre and to evaluate the utility and value of re‐imaging. Patients and methods The prospectively maintained ‘Trauma Audit and Research Network’ database was interrogated to identify patients with urinary tract injuries between January 2014 and December 2017. Patients’ records and imaging were reviewed to identify injury grades, interventions, outcomes, and follow‐up. Results Renal injury was identified in 90 patients (79 males and 11 females). The mean (sd; range) age was 35.5 (17.4; 1.5–94) years. Most of the renal traumas were caused by blunt mechanisms (74%). The overall severity of injuries was: 18 (20%) Grade I, 19 (21%) Grade II, 27 (30%) Grade III, 22 (24%) Grade IV, and four (4%) Grade V. Most patients (84%) were managed conservatively. Early intervention (<24 h) was performed in 14 patients (16%) for renal injuries. Most of these patients were managed by interventional radiology techniques (nine of 14). Only two patients required an emergency nephrectomy, both of whom died from extensive polytrauma. In all, 19 patients underwent laparotomy for other injuries and did not require renal exploration. The overall 30‐day mortality was 13%. Re‐imaging was performed in 66% of patients at an average time of 3.4 days from initial scan. The majority of re‐imaging was planned (49 patients) and 12% of these scans demonstrated a relevant finding (urinoma, pseudoaneurysm) that altered management in three of the 49 patients (6.1%). Conclusion Non‐operative management is the mainstay for all grades of injury. Haemodynamic instability and persistent urine leak are primary indications for intervention. Open surgical management is uncommon. Repeat imaging after injury is advocated for stable patients with high‐grade renal injuries (Grade III–V), although more research is needed to determine the optimal timing.
Issue Date: 11-Apr-2019
Date of Acceptance: 19-Mar-2019
URI: http://hdl.handle.net/10044/1/69598
DOI: https://dx.doi.org/10.1111/bju.14752
ISSN: 1464-4096
Publisher: Wiley
Journal / Book Title: BJU International
Copyright Statement: © 2019 The Authors BJU International © 2019 BJU International Published by John Wiley & Sons Ltd. This is the accepted version of the following article, which has been published in final form at https://onlinelibrary.wiley.com/doi/full/10.1111/bju.14752
Sponsor/Funder: Imperial College Healthcare NHS Trust
Imperial College Healthcare NHS Trust- BRC Funding
Funder's Grant Number: UR150
RDB04
Keywords: #UroTrauma
embolisation
kidney trauma
major trauma centre
re-imaging
renal injury
1103 Clinical Sciences
Urology & Nephrology
Publication Status: Published online
Embargo Date: 2020-03-23
Online Publication Date: 2019-03-23
Appears in Collections:Division of Surgery



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