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Ząbkowski T, Brzozowski R, Durma AD. Renal injuries in conflict zones: a 6-year study of traumatic cases in Afghanistan. Confl Health 2024; 18:6. [PMID: 38183150 PMCID: PMC10770980 DOI: 10.1186/s13031-023-00566-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE During hostilities, gunshot wounds are the most common cause of penetrating injuries. In 8-10% of abdominal injuries kidneys are involved. The treatment method include surgical or conservative treatment (fluids + blood components). METHODS Of 1266 combat trauma cases treated during 6 to 14 rotation of the Polish Military Contingent in Afghanistan, we extracted a subgroup of 44 kidney injuries. Corelation of trauma mechanism, PATI score, treatment methods, and outcomes was evaluated. RESULTS Out of the 41 renal injuries, 20 considered left, 18 right, and 3 both kidneys. There were no statistical significancy in injury lateralization (p = 0.669), and no differences regarding side of a trauma and quantity of blood component used for the treatment (p = 0.246). Nephrectomy was performed on 17 patients (13 left vs. 4 right). A significant correlation between PATI score and the need for a nephrectomy (p = 0.027) was confirmed. Penetrating trauma recquired higher number of blood components comparing to blunt trauma (p < 0.001). The renal salvage rate was in study group was 61.36%. The overall survival (OS) rate was 90.25% - 4 patients died due to trauma. CONCLUSIONS The damage side does not result in a statistically significant increase in the need for blood transfusions or differences in the PATI score. The mechanism of trauma does, however, affect the number of blood components required for treatment, particularly in cases of penetrating trauma. With the introduction of proper treatment, the overall survival rate exceeds 90%, even when opting for conservative treatment.
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Affiliation(s)
- Tomasz Ząbkowski
- Department of Urology, Miliary Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Robert Brzozowski
- Department of General and Oncological Surgery, 5th Military Clinical Hospital with Polyclinic, Cracov, Poland
| | - Adam Daniel Durma
- Department of Endocrinology and Radioisotope Therapy, Miliary Institute of Medicine - National Research Institute, Warsaw, Poland.
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Baboudjian M, Lebacle C, Gondran-Tellier B, Hutin M, Olivier J, Ruggiero M, Panayotopoulos P, Dominique I, Millet C, Bergerat S, Freton L, Betari R, Matillon X, Chebbi A, Caes T, Patard PM, Szabla N, Sabourin L, Dariane C, Rizk J, Madec FX, Nouhaud FX, Rod X, Fiard G, Pradere B, Peyronnet B. Who Is at Risk of Death after Renal Trauma? An Analysis of Thirty-Day Mortality after 1,799 Cases of Renal Trauma. Urol Int 2023; 107:165-170. [PMID: 35390797 DOI: 10.1159/000521554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of the study was to report the 30-day mortality (30DM) after renal trauma and identify the risk factors associated with death. METHODS The TRAUMAFUF project was a retrospective multi-institutional study including all patients with renal trauma admitted to 17 French hospitals between 2005 and 2015. The included population focused on patients of all age groups who underwent renal trauma during the study period. The primary outcome was death within 30 days following trauma. The multivariate logistic regression model with a stepwise backward elimination was used to identify predictive factors of 30DM. RESULTS Data on 1,799 renal trauma were recorded over the 10-year period. There were 59 deaths within 30 days of renal trauma, conferring a 30DM rate of 3.27%. Renal trauma was directly involved in 5 deaths (8.5% of all deaths, 0.3% of all renal trauma). Multivariate stepwise logistic regression analysis revealed that age >40 years (odds ratio [OR] 2.18; 95% confidence interval [CI]: 1.20-3.99; p = 0.01), hemodynamic instability (OR 4.67; 95% CI: 2.49-9; p < 0.001), anemia (OR 3.89; 95% CI: 1.94-8.37; p < 0.001), bilateral renal trauma (OR 6.77; 95% CI: 2.83-15.61; p < 0.001), arterial contrast extravasation (OR 2.09; 95% CI: 1.09-3.96; p = 0.02), and concomitant visceral and bone injuries (OR 6.57; 95% CI: 2.41-23.14; p < 0.001) were independent predictors of 30DM. CONCLUSION Our large multi-institutional study supports that the 30DM of 3.27% after renal trauma is due to the high degree of associated injuries and was rarely a consequence of renal trauma alone. Age >40 years, hemodynamic instability, anemia, bilateral renal trauma, arterial contrast extravasation, and concomitant visceral and bone lesions were predictors of death. These results can help clinicians to identify high-risk patients.
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Affiliation(s)
- Michael Baboudjian
- Department of Urology and Kidney Transplantation, Aix-Marseille University, APHM, Conception Academic Hospital, Marseille, France
| | - Cedric Lebacle
- Department of Urology, University of Paris Sud, CHU Bicetre, Paris, France
| | - Bastien Gondran-Tellier
- Department of Urology and Kidney Transplantation, Aix-Marseille University, APHM, Conception Academic Hospital, Marseille, France
| | - Marine Hutin
- Department of Urology, University of Montpellier, Montpellier, France
| | | | - Marina Ruggiero
- Department of Urology, University of Paris Sud, CHU Bicetre, Paris, France
| | | | | | - Clémentine Millet
- Department of Urology, University of Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Lucas Freton
- Department of Urology, University of Rennes, Rennes, France
| | - Reem Betari
- Department of Urology, University of Amiens, Amiens, France
| | | | - Ala Chebbi
- Department of Urology, University of Rouen, Rouen, France
| | - Thomas Caes
- Department of Urology, University of Lille, Lille, France
| | | | | | - Laura Sabourin
- Department of Urology, University of Clermont-Ferrand, Clermont-Ferrand, France
| | - Charles Dariane
- Department of Urology, University of Paris Descartes, Paris, France
| | - Jerome Rizk
- Department of Urology, University of Lille, Lille, France
| | | | | | - Xavier Rod
- Department of Urology, University of Nantes, Nantes, France
| | - Gaelle Fiard
- Department of Urology, University of Grenoble, Grenoble, France
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Song PH. Frailty and elderly in urology: implications for postoperative complications. Yeungnam Univ J Med 2020; 37:296-301. [PMID: 33027849 PMCID: PMC7606957 DOI: 10.12701/yujm.2020.00752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/17/2020] [Indexed: 11/26/2022] Open
Abstract
The geriatric population is at a greater risk of postoperative complications than young adults. This risk is associated with the physiologic decline seen in this population known as frailty. Unlike fitter patients, frail patients who undergo operative treatment have a greater likelihood of developing postoperative complications and endure prolonged hospital stays. This circumstance is comparable to the urological status. Therefore, tolerable measurement of frailty as a domain of preoperative health status has been suggested to ascertain vulnerability in elderly patients. In this review, we will elaborate on the concept of frailty and examine its importance with respect to surgical complications, focusing on the urological status.
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Affiliation(s)
- Phil Hyun Song
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
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Naeem Z, McCormack JE, Huang EC, Vosswinkel JA, Shapiro MJ, Zarlasht F, Jawa RS. Impact of Type and Number of Complications on Mortality in Admitted Elderly Blunt Trauma Patients. J Surg Res 2019; 241:78-86. [PMID: 31015071 DOI: 10.1016/j.jss.2019.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/01/2019] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Advanced age and comorbidities are recognized risk factors for adverse outcomes in elderly trauma patients. However, the contribution of the number and type of complications to in-hospital mortality in elderly blunt trauma admissions has not been extensively studied. METHODS A retrospective review of the trauma registry at a level 1 trauma center for blunt trauma patients age ≥65 y hospitalized for at least 2 d between 2010 and 2015. RESULTS There were 2467 admissions, with a median age of 81 y and median injury severity score of 9. The most common mechanism of injury was a low-level fall. Approximately 19.6% of admissions had a complication: 11.1% major complications, 8.6% other complications. The in-hospital mortality rate was significantly different (P < 0.001) among the three groups at 16.1% of major complications group, 7.1% of other, and 2.1% of no complications (P < 0.001). On multivariate logistic regression, each major complication increased the odds for in-hospital mortality by 1.59-fold. CONCLUSIONS Complications are not infrequent in elderly blunt trauma admissions, despite a generally lower energy mechanism of injury. Each major complication is associated with increased odds of mortality. Multifaceted interventions for prevention and mitigation of complications are indicated.
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Affiliation(s)
- Zaina Naeem
- Division of Trauma, Department of Surgery, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
| | - Jane E McCormack
- Division of Trauma, Department of Surgery, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
| | - Emily C Huang
- Division of Trauma, Department of Surgery, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
| | - James A Vosswinkel
- Division of Trauma, Department of Surgery, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
| | - Marc J Shapiro
- Division of Trauma, Department of Surgery, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
| | - Fnu Zarlasht
- Division of Geriatric Medicine, Department of Medicine, Stony Brook University School of Medicine, Stony Brook, New York
| | - Randeep S Jawa
- Division of Trauma, Department of Surgery, Stony Brook University Renaissance School of Medicine, Stony Brook, New York.
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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 2018; 5:1135-1142. [PMID: 29934273 DOI: 10.1016/j.euf.2018.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/29/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Renal trauma may be managed differently in tiered trauma systems and among those who requireinterfaculty transfer. OBJECTIVE To evaluate the initial management of renal trauma, assess patterns of management based on hospital trauma level designation and interfacility transfer status, and analyze management trends over time. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of renal trauma from the National Trauma Data Bank 2010-2015. INTERVENTION Nephrectomy, angioembolization, or nonoperative management. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS We used generalized estimating equations to compare odds of each management outcome in patients transferred and directly admitted to a level I center, versus those directly admitted to a non-level I center, adjusting for vital signs, injury, demographic, and facility characteristics. We also used generalized estimating equations to examine linear time trends in management outcome, adjusting for injury characteristics. RESULTS AND LIMITATIONS A total of 51798 renal trauma records were included: 44 838 low-grade (American Association for the Surgery of Trauma I-III) and 6359 high grade (IV-V) injuries. After adjusting for comorbidities, demographics, and hospital characteristics, odds of nephrectomy, angioembolization, and nonoperative management were similar in patients transferred or directly admitted to a level I center compared with those treated at a non-level I center. Changes in management over time demonstrated a decreased rate of nephrectomy (p=0.007) in high-grade injuries, while the rate of angioembolization remained constant (p=0.33). Study limitations include mortality prior to hospital transfer or arrival, and its retrospective nature. CONCLUSIONS In this contemporary trauma analysis, outcomes of both low- and high-grade renal trauma are similar across patients managed in tiered trauma centers and those undergoing transfer, signifying dissemination of collective renal trauma management. The rate of nephrectomy has decreased for high-grade renal injury over our study period, suggesting new adoption of kidney-sparing management. PATIENT SUMMARY Renal trauma is now managed similarly in tiered trauma centers and in patients requiring interfacility transfer. The rate of nephrectomy for high-grade renal injuries has decreased over time.
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Affiliation(s)
- Marc A Bjurlin
- Department of Urology, NYU Langone Hospital-Brooklyn, Brooklyn, NY, USA.
| | - Audrey Renson
- Department of Population Health, NYU Langone Hospital-Brooklyn, Brooklyn, NY, USA; Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA
| | - Richard Jacob Fantus
- Section of Urology, Department of Surgery, The University of Chicago, Chicago, IL, USA
| | - Richard Joseph Fantus
- Department of Surgery, Section of Trauma, and Surgical Critical Care, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
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6
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Comparison of nonoperative and surgical management of renal trauma: Can we predict when nonoperative management fails? J Trauma Acute Care Surg 2017; 82:356-361. [PMID: 27893642 DOI: 10.1097/ta.0000000000001316] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Limited data exist on risk factors for the failure of nonoperative management of renal trauma. Our study objective was to determine the incidence, salvage procedure, and risk factors for failure of nonoperative management of renal trauma. METHODS The National Trauma Data Bank research data sets for admission years 2010-2014 were queried for renal injury by Abbreviated Injury Score code. Patients were stratified by interventional therapy (renal procedure code <24 hours from admission) and nonoperative management (no surgical renal procedure <24 hours). Abbreviated Injury Score was converted to American Association for the Surgery of Trauma renal injury grade. Demographics, patient and injury characteristics were compared between groups using stratified analysis. Multivariable logistic regression models were used to determine variables that were associated with failure of nonoperative management. RESULTS A review of 3,977,634 cases revealed 19,572 renal injuries that met study criteria. A total of 16.6% were managed with interventional therapy, and 83.4% were managed nonoperatively, of which 2.7% failed nonoperative management. Risk-adjusted multivariate regression indicated that penetrating injury (stab: odds ratio [OR], 1.61; 95% confidence interval [CI], 1.02-2.53 [p = 0.040]; and gunshot wound: OR, 1.40; 95% CI, 1.04-1.90 [p = 0.029]), highest abdominal injury grade for nonrenal organs (OR, 2.06; 95% CI, 1.65-2.57), and highest renal injury grade (OR, 1.85; 95% CI, 1.54-2.21) were associated with failure of nonoperative management (all p < 0.001). Increasing injury grades were associated with increasing risk of failing nonoperative management (Grade III: OR, 1.94; 95% CI, 1.35-2.90; Grade IV: OR, 9.79; 95% CI, 7.04-13.63; and Grade V: OR, 9.45; 95% CI, 6.02-14.86 [all p < 0.001]). CONCLUSIONS Nonoperative management in the first 24 hours after fails in up to 2.7%. Renal injury grade, nonrenal abdominal injuries, and penetrating injuries predict for nonoperative management failure. Highest-grade renal injuries are at increased risk of failure. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III; therapeutic study, level IV.
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7
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Pangilinan J, Quanstrom K, Bridge M, Walter LC, Finlayson E, Suskind AM. The Timed Up and Go Test as a Measure of Frailty in Urologic Practice. Urology 2017; 106:32-38. [PMID: 28477941 DOI: 10.1016/j.urology.2017.03.054] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/27/2017] [Accepted: 03/09/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the prevalence of frailty, a known predictor of poor outcomes, among patients presenting to an academic nononcologic urology practice and to examine whether frailty differs among patients who did and did not undergo urologic surgery. METHODS The Timed Up and Go Test (TUGT), a parsimonious measure of frailty, was administered to patients ages ≥65. The TUGT, demographic data, urologic diagnoses, and procedural history were abstracted from the medical record into a prospective database. TUGT times were categorized as nonfrail (≤10 seconds), prefrail (11-14 seconds), and frail (≥15 seconds). These times were evaluated across age and urologic diagnoses and compared between patients who did and did not undergo urologic surgery using chi-square and t tests. RESULTS The TUGT was recorded for 78.9% of patient visits from December 2015 to May 2016. For 1089 patients, average age was 73.3 ± 6.3 years; average TUGT time was 11.6 ± 6.0 seconds; 30.0% were categorized as prefrail and 15.2% as frail. TUGT times increased with age, with 56.9% of patients age 86 and over categorized as frail. Times varied across diagnoses (highest average TUGT was 14.3 ± 11.9 seconds for patients with urinary tract infections); however, no difference existed between patients who did and did not undergo surgery (P = .94). CONCLUSION Among our population, prefrailty and frailty were common, TUGT times increased with age and varied by urologic diagnosis, but did not differ between patients who did and did not undergo urologic surgery, presenting an opportunity to consider frailty in preoperative surgical decision making.
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Affiliation(s)
| | | | - Mark Bridge
- Department of Urology, University of California, San Francisco, CA
| | - Louise C Walter
- Division of Geriatrics, University of California, San Francisco, CA; Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, CA
| | - Emily Finlayson
- Department of Surgery, University of California, San Francisco, CA
| | - Anne M Suskind
- Department of Urology, University of California, San Francisco, CA.
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8
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Abstract
Testicular trauma is a rare emergency. While penetrating injuries need surgical revision, blunt injuries may be treated conservatively. However, in case of testicular rupture early surgical intervention increases the chance of testicular preservation. Therefore, a meticulous urological diagnosis is important to avoid complications and to reduce rates of secondary orchiectomy.
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Affiliation(s)
- B Lyttwin
- Urologische Universitätsklinik, Anna-Seiler-Haus, Inselspital Bern, Freiburgstraße 10, 3010, Bern, Schweiz
| | - F Moltzahn
- Urologische Universitätsklinik, Anna-Seiler-Haus, Inselspital Bern, Freiburgstraße 10, 3010, Bern, Schweiz
| | - G N Thalmann
- Urologische Universitätsklinik, Anna-Seiler-Haus, Inselspital Bern, Freiburgstraße 10, 3010, Bern, Schweiz.
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9
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Abstract
The kidney is the most commonly injured genitourinary organ, and renal involvement has been reported in 1–5% of all trauma cases. Two mechanisms of renal injury are described, namely blunt (direct blow to the kidney, rapid acceleration/deceleration or a combination) and penetrating (from stab or gunshot wounds), with blunt injuries being most common in the UK. It is important to keep an index of suspicion for renal trauma as given by the mechanism of the injury or in poly-trauma. Accurate assessment and resuscitation are vital in the initial management. Imaging with computed tomography is critical to the accurate grading of the injury and helps guide subsequent treatment. The approach to management of renal injuries has changed over time. During the past two decades, advances in cross-sectional imaging coupled with minimally invasive intervention strategies (like angiography, embolisation and ureteric stenting) for managing traumatic renal injuries have allowed increased renal preservation by reducing the need for major surgical intervention. Nowadays, the vast majority of blunt injuries (up to 95%) are managed conservatively with accumulated experience suggesting this is safe. However, there is still a role for open surgical exploration in patients with haemodynamic instability or those who fail initial conservative/minimally invasive management.
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10
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Abstract
PURPOSE OF REVIEW The geriatric population is the fastest growing segment of the population, and geriatric trauma patients are increasingly common. Caring for this population has unique challenges. The goal of the review is to identify factors that may help in the care of geriatric patients suffering from genitourinary trauma. RECENT FINDINGS Multiple factors lead to inferior outcomes in patients with geriatric trauma including failure to rescue, treatment in lower volume trauma centers, and undertriage of geriatric patients. Improvement in geriatric trauma outcomes occurs with the use of dedicated geriatric consult teams. The surgical management of genitourinary injuries in the geriatric population remains unchanged. SUMMARY Interventions for geriatric patients differ from younger populations. Direct changes in overall management of the geriatric population lead to improved outcomes. The treatment of geriatric trauma patients with genitourinary injuries is similar to a younger cohort. The lack of recent studies in clinical outcomes in this population has been identified as a gap in knowledge that will require future research to answer.
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Wang Z, Yang JR, Huang YM, Wang L, Liu LF, Wei YB, Huang L, Zhu Q, Zeng MQ, Tang ZY. Diagnosis and management of testicular rupture after blunt scrotal trauma: a literature review. Int Urol Nephrol 2016; 48:1967-1976. [PMID: 27567912 DOI: 10.1007/s11255-016-1402-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 08/17/2016] [Indexed: 12/12/2022]
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12
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Affiliation(s)
- A N Smolyar
- N.V. Sklifosovsky Research Institute of Emergency Care, Moscow, Russia
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13
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Townsend NT, Robinson TN. Surgical Risk and Comorbidity in Older Urologic Patients. Clin Geriatr Med 2015; 31:591-601. [DOI: 10.1016/j.cger.2015.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kautza B, Zuckerbraun B, Peitzman AB. "Management of blunt renal injury: what is new?". Eur J Trauma Emerg Surg 2015; 41:251-8. [PMID: 26038034 DOI: 10.1007/s00068-015-0516-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 03/11/2015] [Indexed: 11/24/2022]
Abstract
The diagnosis, workup and management of blunt renal injury have evolved greatly over the past decades. Evaluation and management of blunt renal injury echoes the increasing success of nonoperative management in other blunt abdominal solid organ injury, such as liver and spleen. Decision-making difficulties still remain regarding the optimal imaging, grading and degree of interventional or operative exploration used. Increasingly, initial nonoperative management has gained acceptance and appears to be applicable even high-grade injuries. Emerging techniques in highly sensitive imaging as well as interventional angiography have allowed safe nonoperative management in the appropriate patient. This review will focus on the contemporary workup and management of blunt renal injury while focusing on some of the emerging literatures in regard to refined imaging and grading of injuries as well as techniques to increase the success of nonoperative management.
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Affiliation(s)
- B Kautza
- Department of Surgery, University of Pittsburgh, F1200 PUH 200 Lothrop St, Pittsburgh, PA, 15213, USA
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15
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Bjurlin MA, Fantus RJ, Fantus RJ, Mellett MM, Villines D. The impact of seat belts and airbags on high grade renal injuries and nephrectomy rate in motor vehicle collisions. J Urol 2014; 192:1131-6. [PMID: 24846798 DOI: 10.1016/j.juro.2014.04.093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Motor vehicle collisions are the most common cause of blunt genitourinary trauma. We compared renal injuries with no protective device to those with seat belts and/or airbags using NTDB. Our primary end point was a decrease in high grade (grades III-V) renal injuries with a secondary end point of a nephrectomy rate reduction. MATERIALS AND METHODS The NTDB research data sets for hospital admission years 2010, 2011 and 2012 were queried for motor vehicle collision occupants with renal injury. Subjects were stratified by protective device and airbag deployment. The AIS was converted to AAST renal injury grade and nephrectomy rates were evaluated. Intergroup comparisons were analyzed for renal injury grades, nephrectomy, length of stay and mortality using the chi-square test or 1-way ANOVA. The relative risk reduction of protective devices was determined. RESULTS A review of 466,028 motor vehicle collisions revealed a total of 3,846 renal injuries. Injured occupants without a protective device had a higher rate of high grade renal injuries (45.1%) than those with seat belts (39.9%, p = 0.008), airbags (42.3%, p = 0.317) and seat belts plus airbags (34.7%, p <0.001). Seat belts (20.0%), airbags (10.5%) and seat belts plus airbags (13.3%, each p <0.001) decreased the nephrectomy rate compared to no protective device (56.2%). The combination of seatbelts and airbags also decreased total hospital length of stay (p <0.001) and intensive care unit days (p = 0.005). The relative risk reductions of high grade renal injuries (23.1%) and nephrectomy (39.9%) were highest for combined protective devices. CONCLUSIONS Occupants of motor vehicle collisions with protective devices show decreased rates of high grade renal injury and nephrectomy. Reduction appears most pronounced with the combination of seat belts and airbags.
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Affiliation(s)
- Marc A Bjurlin
- Department of Urology, New York University Langone Medical Center, New York University School of Medicine, New York, New York
| | | | - Richard Joseph Fantus
- Section of Trauma, Department of Surgery and Surgical Critical Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois.
| | - Michele M Mellett
- Section of Trauma, Department of Surgery and Surgical Critical Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois
| | - Dana Villines
- Department of Research, Advocate Health Care, Chicago, Illinois
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Shoobridge JJ, Bultitude MF, Koukounaras J, Martin KE, Royce PL, Corcoran NM. A 9-year experience of renal injury at an Australian level 1 trauma centre. BJU Int 2013; 112 Suppl 2:53-60. [DOI: 10.1111/bju.12003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Matthew F. Bultitude
- Urology Centre, Guy's and St. Thomas' Hospital NHS, Foundation Trust; Guy's Hospital; London UK
| | - Jim Koukounaras
- Department of Radiology; Alfred Hospital; Melbourne Vic. Australia
| | | | - Peter L. Royce
- Department of Urology; Alfred Hospital; Melbourne Vic. Australia
| | - Niall M. Corcoran
- Department of Surgery; Royal Melbourne Hospital; University of Melbourne; Parkville Vic. Australia
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