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World Journal of Emergency Surgery
Published in: World Journal of Emergency Surgery 1/2020

Open Access 01-12-2020 | Nephrectomy | Research article

Trends and outcomes of blunt renal trauma management: a nationwide cohort study in Japan

Authors: Shunichiro Nakao, Yusuke Katayama, Atsushi Hirayama, Tomoya Hirose, Kenichiro Ishida, Yutaka Umemura, Jotaro Tachino, Takeyuki Kiguchi, Tasuku Matsuyama, Kosuke Kiyohara, Tetsuhisa Kitamura, Yuko Nakagawa, Takeshi Shimazu

Published in: World Journal of Emergency Surgery | Issue 1/2020

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Abstract

Background

There is a paucity of information for predicting patient outcomes other than the American Association for the Surgery of Trauma (AAST) renal injury scale. The aim of this study was to evaluate the association between the patient characteristics and outcomes of patients with blunt renal trauma using a nationwide database in Japan.

Methods

We performed a retrospective analysis of the Japan Trauma Data Bank (JTDB) from 2004 to 2018. We identified patients with blunt renal trauma by AIS codes converted to AAST grades. We evaluated trends in patient characteristics and management and assessed factors associated with mortality and nephrectomy using a multivariable logistic regression analysis.

Results

We identified 3550 patients with blunt renal trauma. Their median age was 43 years and 74.2% were male. Nephrectomy was performed in 3.8%, and the overall mortality rate was 9.5%. We found increasing trends in age and emergency abdominal angiography and decreasing trends in nephrectomy and mortality over the 15-year period. The following factors were associated with mortality: age ≥ 65 years (adjusted OR 3.36); pedestrian accident (adjusted OR 1.94); fall from height (adjusted OR 1.91); shock on arrival (adjusted OR 4.02); concomitant injuries to the head/neck (adjusted OR 3.14), pelvis/lower-extremity (adjusted OR 1.59), liver (adjusted OR 1.68), spleen (adjusted OR 1.45), and gastrointestinal tract (adjusted OR 1.90); AAST grades III–V (adjusted ORs 1.42, 2.16, and 5.55); and emergency abdominal angiography (adjusted OR 0.70). The following factors were associated with nephrectomy: shock on arrival (adjusted OR 1.98), concomitant injuries to the thorax (adjusted OR 0.46) and spleen (adjusted OR 2.07), AAST grades III, IV, and V (adjusted ORs 18.40, 113.89, and 468.17), and emergency abdominal angiography (adjusted OR 0.28).

Conclusions

We demonstrated that the AAST grade and emergency angiography were associated with mortality and nephrectomy in blunt renal trauma in the Japanese population.
Literature
1.
Meng MV, Brandes SB, McAninch JW. Renal trauma: indications and techniques for surgical exploration. World J Urol. 1999;17(2):71–7.CrossRef
2.
Smith J, Caldwell E, D’Amours S, Jalaludin B, Sugrue M. Abdominal trauma: a disease in evolution. ANZ J Surg. 2005;75(9):790–4.CrossRef
3.
Santucci RA, Fisher MB. The literature increasingly supports expectant (conservative) management of renal trauma - a systematic review. J Trauma. 2005;59(2):493–503.CrossRef
4.
Mingoli A, La Torre M, Migliori E, Cirillo B, Zambon M, Sapienza P, Brachini G. Operative and nonoperative management for renal trauma: comparison of outcomes. A systematic review and meta-analysis. Ther Clin Risk Manag. 2017;13:1127–38.CrossRef
5.
Sujenthiran A, Elshout PJ, Veskimae E, MacLennan S, Yuan Y, Serafetinidis E, et al. Is nonoperative management the best first-line option for high-grade renal trauma? A systematic review. Eur Urol Focus. 2019;5(2):290–300.CrossRef
6.
Colaco M, Navarrete RA, MacDonald SM, Stitzel JD, Terlecki RP. Nationwide procedural trends for renal trauma management. Ann Surg. 2019;269(2):367–9.CrossRef
7.
Aldiwani M, Georgiades F, Omar I, Angel-Scott H, Tharakan T, Vale J, Mayer E. Traumatic renal injury in a UK major trauma centre – current management strategies and the role of early re-imaging. BJU Int 2019 (in press).
8.
Morey AF, Brandes S, Dugi DD 3rd, Armstrong JH, Breyer BN, Broghammer JA, et al. Urotrauma: AUA guideline. J corUrol. 2014;192(2):327–35.
9.
Lynch TH, Martínez-Piñeiro L, Plas E, Serafetinides E, Türkeri L, Santucci RA, Hohenfellner M. European Association of Urology. EAU guidelines on urological trauma. Eur Urol. 2005;47(1):1–15.CrossRef
10.
Coccolini F, Moore EE, Kluger Y, Biffl W, Leppaniemi A, Matsumura Y, et al. Kidney and uro-trauma: WSES-AAST guidelines. World J Emerg Surg. 2019;14(54):1–25.
11.
van der Wilden GM, Velmahos GC, Joseph DK, Jacobs L, Debusk MG, Adams CA, et al. Successful nonoperative management of the most severe blunt renal injuries: a multicenter study of the research consortium of new England centers for trauma. JAMA Surg. 2013;148(10):924–31.CrossRef
12.
Kuan JK, Wright JL, Nathens AB, Rivara FP, Wessells H. American Association for the Surgery of Trauma Organ Injury Scale for Kidney Injuries predicts nephrectomy, dialysis. J Trauma Inj Infect Crit Care. 2006;60(2):351–6.CrossRef
13.
Shoko T, Shiraishi A, Kaji M, Otomo Y. Effect of pre-existing medical conditions on in-hospital mortality: analysis of 20,257 trauma patients in Japan. J Am Coll Surg. 2010;211:338–46.CrossRef
14.
15.
Kurtz MP, Eswara JR, Vetter JM, Nelson CP, Brandes SB. Blunt abdominal trauma from motor vehicle collisions from 2007 to 2011: renal injury probability and severity in children versus adults. J Urol. 2017;197(3):906–10.CrossRef
16.
Bjurlin MA, Fantus RJ, Fantus RJ, Villines D. Comparison of nonoperative and surgical management of renal trauma: can we predict when nonoperative management fails? J Trauma Acute Care Surg. 2017;82(2):356–61.CrossRef
17.
Bjurlin MA, Renson A, Fantus RJ, Fantus RJ. Impact of trauma center designation and interfacility transfer on renal trauma outcomes: evidence for universal management. Eur Urol Focus. 2019;5(6):1135–42.CrossRef
18.
Neidel T, Salvador N, Heller R. Impact of systolic blood pressure limits on the diagnostic value of triage algorithms. Scand J Trauma Resusc Emerg Med 2017;25(118).
19.
Wessells H, Suh D, Porter JR, Rivara F, MacKenzie EJ, Jurkovich GJ, Nathens AB. Renal injury and operative management in the United States: results of a population-based study. J Trauma. 2003;54(3):423–30.CrossRef
20.
Christensen K, Doblhammer G, Rau R, Vaupel JW. Ageing populations: the challenges ahead. Lancet. 2009;374:1196–208.CrossRef
21.
Nakahara S, Ichikawa M, Kimura A. Population strategies and high-risk-individual strategies for road safety in Japan. Health Policy (New. York). 2011;100(2–3):247–55.CrossRef
22.
Nagata T, Setoguchi S, Hemenway D, Perry MJ. Effectiveness of a law to reduce alcohol-impaired driving in Japan. Inj Prev. 2008;14(1):19–23.CrossRef
23.
Mann U, Zemp L, Rourke KF. Contemporary management of renal trauma in Canada: a 10-year experience at a level 1 trauma centre. Can Urol Assoc J. 2019;13(6):E177–82.PubMed
24.
Mackenzie EJ. Epidemiology of injuries: current trends and future challenges. Epidemiol Rev. 2000;22(1):112–9.CrossRef
25.
Tinkoff G, Esposito TJ, Reed J, Kilgo P, Fildes J, Pasquale M, Meredith JW. American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank. J Am Coll Surg. 2008;207:646–55.CrossRef
26.
Wright JL, Nathens AB, Rivara FP, Wessells H. Renal and extrarenal predictors of nephrectomy from the National Trauma Data Bank. J Urol. 2006;175:970–5.CrossRef
27.
McClung CD, Hotaling JM, Wang J, Wessells H, Voelzke BB. Contemporary trends in the immediate surgical management of renal trauma using a national database. J Trauma Acute Care Surg. 2013;75(4):602–6.CrossRef
28.
Chang R, Cardenas JC, Wade CE, Holcomb JB. Advances in the understanding of trauma-induced coagulopathy. Blood. 2016;128(8):1043–9.CrossRef
29.
Wright AP, Wade CE, Camp EA, Caga-Anan Z, Radwan Z, Minei K, et al. Pulmonary contusion on admission chest X-ray is associated with coagulopathy and mortality in trauma patients. Emerg Med Trauma Surg Care. 2015;2(3):1–5.CrossRef
30.
Brewer ME Jr, Strnad BT, Daley BJ, Currier RP, Klein FA, Mobley JD, Kim ED. Percutaneous embolization for the management of grade 5 renal trauma in hemodynamically unstable patients: initial experience. J Urol. 2009;181(4):1737–41.CrossRef
31.
Patel DP, Redshaw JD, Breyer BN, Smith TG, Erickson BA, Majercik SD, et al. High-grade renal injuries are often isolated in sports-related trauma. Injury. 2016;46(7):1245–9.CrossRef
32.
Nakao S, Katayama Y, Kitamura T, Hirose T, Sado J, Ishida K, et al. Epidemiological profile of emergency medical services in Japan: a population-based descriptive study in 2016. Acute Med Surg 2020;7(e485).
33.
Ikegami N, Yoo BK, Hashimoto H, Matsumoto M, Ogata H, Babazono A, et al. Japanese universal health coverage: evolution, achievements, and challenges. Lancet. 2011;378:1106–15.CrossRef
Metadata
Title
Trends and outcomes of blunt renal trauma management: a nationwide cohort study in Japan
Authors
Shunichiro Nakao
Yusuke Katayama
Atsushi Hirayama
Tomoya Hirose
Kenichiro Ishida
Yutaka Umemura
Jotaro Tachino
Takeyuki Kiguchi
Tasuku Matsuyama
Kosuke Kiyohara
Tetsuhisa Kitamura
Yuko Nakagawa
Takeshi Shimazu
Publication date
01-12-2020
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2020
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/s13017-020-00329-w

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