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

Abstract

In this retrospective study we reviewed the outcome of non-operative management of high-grade blunt renal injuries (grade III–V) and evaluated the predictive indicators of management failure. The data review included the patients’ demographics, the mechanism of trauma and the clinical characteristics, as well as the laboratory and imaging data upon admission and at follow-up. The data of the patients who were successfully managed non-operatively and of those who needed intervention for renal injuries were compared. Two hundred and six patients were enrolled in this study. Grade III, grade IV and grade V renal injuries were found in 39.8%, 44.2% and 16% of the patients, respectively. The overall success rate of non-operative management was 87.9%, including all patients with grade III, 86.8% of patients with grade IV and 60.6% of those with grade V injuries. Multivariate analysis revealed that trauma secondary to motor vehicle accident, hypotension at presentation, associated injuries to other organs, grade V renal injury and computed tomography (CT) imaging features, namely medial renal parenchymal laceration, perirenal hematoma ≥3.5 cm and intravascular extravasation were significant predictors for failure of non-operative management. Our findings suggest that high-grade renal injuries in hemodynamically stable patients can be managed conservatively with a high success rate. Multiple clinical and radiological variables can predict the treatment outcome.