Severe blunt renal trauma: a 7-year retrospective review from a provincial trauma centre.

BACKGROUND: Renal trauma is reported in 3% of trauma patients. The majority (>90%) are due to blunt mechanisms of injury. Minor renal injuries pose few management difficulties and the majority are managed expectantly. More serious injuries are potentially life threatening and have been historically managed by operative intervention with repair of the injured kidney when possible. More recently, there has been a trend towards non-operative management of all solid intra-abdominal organ injury including renal trauma. The purpose of this study was to review a 7-year experience in renal trauma at a provincial trauma centre and to define management practices along with patient and organ outcomes in severe renal injury.

METHODS: The BC Trauma Registry was reviewed for all admissions from January 1, 1992 to December 31, 1998 to identify patients with renal injury. Patient charts were reviewed to determine sex, age, mechanism of injury, vitals, imaging, associated injuries, and management and outcomes. Renal injuries were graded according to the American Association for the Surgery of Trauma Grading System.

RESULTS: During the study period 16 250 consecutive trauma cases were seen at Vancouver General Hospital. Of these cases, 227 (1.4%) patients sustained renal injuries: blunt in 93.4% and penetrating in 6.6%. Among patients with blunt renal trauma, 18.3% were grade III, IV, or V injuries. In this population, nearly 80% had associated trauma and also 80% had gross hematuria. Management was conservative in 87.5% of grade III and 77.7% of grade IV; however, 90.9% of grade V injuries went immediately to the OR. Nephrectomy rates were: 12.5% (III), 16.6% (IV), and 90.9% (V) with an overall exploration rate of 7.1% for all blunt renal trauma. Blunt renal trauma patients experienced few genitourinary complications. Overall, 3 patients of 40 with grade III, IV or V injuries died due to cardiac arrest in the emergency room.

CONCLUSIONS: Blunt renal trauma managed conservatively is associated with few complications in the hemodynamically stable patient. Grade V injuries still result in a nephrectomy rate of 90.9% with hemodynamic instability the indication in 100% of patients.