Initial radiological findings associated with active bleeding control necessity and long term functional outcomes after isolated high grade blunt renal trauma

•In blunt HGRT, conservative management can be successfully and safely elicited.•Increased HRD and presence of VCE can reflect the severity of the renal injury.•Laceration number and renal devascularization are indicators for active treatment.•Ipsilateral RPV decrease with contralateral compensatory...

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Bibliographic Details
Published in:Injury 2021-05, Vol.52 (5), p.1190-1197
Main Authors: Elbaset, M.A., Abouelkheir, Rasha T., El-Baz, Ramy, Ashour, Rawdy, Osman, Yasser
Format: Article
Language:English
Subjects:
High grade renal trauma
Renal
Renal function
Trans-arterial embolization (TAE)
Trauma
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Summary:•In blunt HGRT, conservative management can be successfully and safely elicited.•Increased HRD and presence of VCE can reflect the severity of the renal injury.•Laceration number and renal devascularization are indicators for active treatment.•Ipsilateral RPV decrease with contralateral compensatory RPV increase was observed.•Parenchymal devascularization in addition is an indicator for RPV decrease. Introduction: To assess the predictors for conservative management failure and long term outcomes after isolated blunt high grade renal trauma (HGRT). Methods: A retrospective analysis of patients with isolated blunt HGRT (renal trauma grade ≥ IV) was conducted. Patients’ demographics, clinical presentation, laboratory and radiological investigations, and different lines of treatment were retrieved. The primary outcome was to assess the predictors of conservative treatment failure (need for active bleeding control e.g.: transarterial angioembolization (TAE) and/or surgical exploration). The secondary outcome was to assess the renal parenchymal volume (RPV) changes post HGRT in correlation with the different lines of management using CT-measured RPV. The difference in RPV ≥ 5% at follow up was considered significant. Results: The study included 63 patients, mean (SD) age was 35.1 (16.6) years. Conservative management was successful in 39 patients (62%), while the need for active bleeding control was required in 16 and 8 patients who underwent TAE and surgical exploration, respectively. Increased hematoma rim distance (HRD), laceration numbers > 3, parenchymal devascularization ≥ 25%, and presence of vascular contrast extravasation (VCE) were predictors for conservative treatment failure (P= 0.006, 0.02, 0.045 and 0.002, respectively). After a mean of 19 months follow up, patients were subclassified into 2 groups: patients with preserved RPV (28 patients) and patients with decreased RPV (29 patients). Renal parenchymal devascularization ≥ 25% was found a predictor for ipsilateral RPV decrease (P = 0.02). Conclusion: Increased HRD, laceration numbers > 3, parenchymal devascularization ≥ 25%, and presence of VCE are findings that reflect the necessity for active bleeding interventions after isolated blunt HGRT. Parenchymal devascularization ≥ 25% is an independent factor for RPV deterioration. Neither the grade of renal trauma nor the type of treatment is a predictor for such deterioration.
ISSN:0020-1383
1879-0267
DOI:10.1016/j.injury.2021.03.038