Selective nonoperative management of blunt grade 5 renal injury.
OBJECTIVE
We determined the feasibility of a nonoperative approach to blunt grade 5 renal injury.


METHODS
We retrospectively reviewed the records of all patients with grade 5 renal injury who presented to our level 1 trauma center from 1993 to 1998. Those treated nonoperatively and surgically were assigned to groups 1 and 2, respectively. Each group was compared with respect to the initial emergency department evaluation, computerized tomography findings, associated injuries, duration of hospital stay and intensive care unit stay, transfusion requirements, complications and followup imaging.


RESULTS
Of 218 renal injuries evaluated 13 were grade 5. In group 1, 6 patients were treated nonoperatively and in group 2, 7 underwent exploration. Each group had similar average hospitalization (12.0 and 12.8 days, respectively). Patients in group 1 had fewer intensive care unit days (4.3 versus 9.0), significantly lower transfusion requirements (2.7 versus 25.2 units, p = 0.0124) and fewer complications during the hospital course. Followup computerized tomography of nonoperatively managed cases revealed functioning renal parenchyma with resolution of retroperitoneal hematoma.


CONCLUSIONS
Conservative management of blunt grade 5 renal injury is feasible in patients who are hemodynamically stable at presentation.
Altman
A L
AL
Case Western Reserve University, Metrohealth Medical Center, Cleveland, Ohio, USA.
Haas
C
C
Dinchman
K H
KH
Spirnak
J P
JP
D000293:Adolescent; D000328:Adult; D002648:Child; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007668:Kidney / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000628:therapy*