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Sarang B, Raykar N, Gadgil A, Mishra G, Wärnberg MG, Rattan A, Khajanchi M, Soni KD, Mohan M, Sharma N, Kumar V, Kv D, Roy N. Outcomes of Renal Trauma in Indian Urban Tertiary Healthcare Centres: A Multicentre Cohort Study. World J Surg 2021; 45:3567-3574. [PMID: 34420094 PMCID: PMC8572839 DOI: 10.1007/s00268-021-06293-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Renal trauma is present in 0.5-5% of patients admitted for trauma. Advancements in radiologic imaging and minimal-invasive techniques have led to decreased need for surgical intervention. We used a large trauma cohort to characterise renal trauma patients, their management and outcomes. METHODS We analysed "Towards Improved Trauma Care Outcomes in India" cohort from four urban tertiary public hospitals in India between 1st September 2013 and 31st December 2015. The data of patients with renal trauma were extracted using International Classification of Diseases 10 codes and analysed for demographic and clinical details. RESULTS A total of 16,047 trauma patients were included in this cohort. Abdominal trauma comprised 1119 (7%) cases, of which 144 (13%) had renal trauma. Renal trauma was present in 1% of all the patients admitted for trauma. The mean age was 28 years (SD-14.7). A total of 119 (83%) patients were male. Majority (93%) were due to blunt injuries. Road traffic injuries were the most common mechanism (53%) followed by falls (29%). Most renal injuries (89%) were associated with other organ injuries. Seven of the 144 (5%) patients required nephrectomy. Three patients had grade V trauma; all underwent nephrectomy. The 30-day in-hospital mortality, in patients with renal trauma, was 17% (24/144). CONCLUSION Most renal trauma patients were managed nonoperatively. 89% of patients with renal trauma had concomitant injuries. The renal trauma profile from this large cohort may be generalisable to urban contexts in India and other low- and middle-income countries.
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Affiliation(s)
- Bhakti Sarang
- Department of Surgery, Terna Medical College and Hospital, New Mumbai, India
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMIC, Mumbai, India
| | - Nakul Raykar
- Trauma and Emergency Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Anita Gadgil
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMIC, Mumbai, India
- Department of Surgery, Bhabha Atomic Research Centre Hospital, Mumbai, India
| | - Gunjan Mishra
- Department of Surgery, Mahatma Gandhi Mission Medical College and Hospital, New Mumbai, India
| | - Martin Gerdin Wärnberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
| | - Amulya Rattan
- Department of Trauma Surgery and Critical Care, All India Institute of Medical Sciences, Rishikesh, India
| | - Monty Khajanchi
- Department of Surgery, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Kapil Dev Soni
- Critical and Intensive Care, JPN Apex Trauma Hospital, AIIMS, New Delhi, India
| | - Monali Mohan
- Health Systems Strengthening, Muzaffarpur Field Health Laboratory, CARE-India, Patna, Bihar, India
| | - Naveen Sharma
- Department of General Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Vineet Kumar
- Department of Surgery, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, India
| | - Deepa Kv
- Department of Surgery, Manipal Hospital, Dwarka, Delhi, India
| | - Nobhojit Roy
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMIC, Mumbai, India.
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden.
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Salem MS, Urry RJ, Kong VY, Clarke DL, Bruce J, Laing GL. Traumatic renal injury: Five-year experience at a major trauma centre in South Africa. Injury 2020; 51:39-44. [PMID: 31668576 DOI: 10.1016/j.injury.2019.10.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/16/2019] [Accepted: 10/14/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study is intended to assess the current optimal management of traumatic renal injuries (TRIs), with a focus on high-grade and penetrating injuries. METHODS The Pietermaritzburg Metropolitan Trauma Service registry was interrogated retrospectively for patients managed for TRI between 1 January 2012 and 31 December 2016. RESULTS Of 13,315 inured patients treated by the PMTS, 223 (1.7%) had TRIs with an incidence of 1.5 per 100,000 population per year. The majority were males between 20 and 39 years of age. The distribution of mechanism of injury was 56.1% (n = 125) blunt and 43.9% (n = 98) penetrating trauma with no association between mechanism and grade of injury. Penetrating trauma was associated with hollow viscus and diaphragm injuries and blunt trauma with solid organ injuries. A total of 118 patients (52.9%) were managed non-operatively, 60 (26.9%) were not explored at operation, 27 (12.1%) underwent initial nephrectomy and 8 (3.6%) underwent renorraphy. Low-grade injuries (AAST I and II) and high-grade injuries (AAST III-V) were managed without renal intervention (non-operatively or not explored at laparotomy for associated injuries) in 88.7% (n = 87) and 72.0% (n = 91) of cases respectively. Blunt and penetrating injuries were managed without renal intervention in 87.9% (n = 109) and 70% (n = 69) of cases respectively. The initial nephrectomy rate was 1% (n = 1) and 20.6% (n = 26) for low- and high-grade injuries respectively, and 6.5% (n = 8) and 19% (n = 19) for blunt and penetrating injuries respectively. High grade (AAST III-V) injury (OR 14.94; 95% CI 3.36 - 66.34; p<0.001), penetrating mechanism (OR 4.99; 95% CI 1.98 - 12.52; p = 0.001) and metabolic acidosis (OR 2.73; 95% CI 1.04 - 7.20; p = 0.042) were significant risk factors for nephrectomy. Four patients (1.8%) underwent ureteral stent insertion and 2 (0.9%) underwent embolisation. The failure rate of initial non-operative management was 1.1%. The mortality rate was 8.1% (n = 18), but no patients with solitary renal injuries died. CONCLUSION Even in high-grade injuries and penetrating trauma, the majority of patients with TRI can be managed non-operatively or with the assistance of endourological or endovascular techniques, with good outcomes. Risk factors for nephrectomy include the presence of high-grade injuries, penetrating trauma and metabolic acidosis on presentation.
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Affiliation(s)
- M S Salem
- Department of Urology, University of KwaZulu-Natal, Durban, South Africa
| | - R J Urry
- Department of Urology, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.
| | - V Y Kong
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa; Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - D L Clarke
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa; Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - J Bruce
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - G L Laing
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
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Abstract
Background: Renal trauma is less common but often occurs in polytrauma. Most trauma is blunt and the severity of the injury varies in different circumstances. Assessment: There is a series of features that should prompt investigation but none are reliably seen in all trauma cases and a low threshold for suspecting renal injury should be taken. A urine dip is essential. Investigation: Computerised tomography is the main modality. Follow-up imaging may be used if complications arise and ultrasound may be used in some cases. Management: Approaches include surgical, radiological and conservative. The latter has been achieved in all grades but intervention will be required in haemodynamic instability. Complications: Haemorrhage, infection and urine extravasation are common and require intervention. There are many long-term complications and hypertension can occur by a variety of mechanisms.
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Affiliation(s)
- James Austin
- Department of Urology, Hampshire Hospitals Foundation Trust, UK
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