Is early reimaging CT scan necessary in patients with grades III and IV renal trauma under conservative treatment?
BACKGROUND
To clarify the role of reimaging computer tomography (CT) scan in the management of patients with grades III and IV renal trauma under conservative treatment.


METHODS
In a cross-sectional study, 94 patients with grades III and IV renal trauma from 405 patients with renal injury were selected for nonoperative management. On arrival according to related indications, CT scan of the kidney was performed for all patients and repeated CT scans were done 36 hours and 5 days later.


RESULTS
Repeated CT scans, 36 hours and 5 days after the injury, revealed evidence of change in hematoma size or increase in urinary leakage only in nine patients. Interestingly, all of them had other clinical findings including fever, hematoma, and flank pain. Conservative therapy was failed in 41 patients. Nephrectomy was performed in 10 patients (24.39%) and repair of the kidney in 31 subjects (75.61%). The causes of failure in conservative treatment were high-grade unremitting fever (>39 degrees C) in 24 patients (58.54%), fever and hematocrit drop in 9 (21.95%), and severe flank pain in 8 (19.51%).


CONCLUSIONS
In patients with high-grade renal trauma under conservative treatment, notification of hemodynamic and vital signs instability and laboratory data are more important than the results of reimaging CT scan. Reimaging CT is not accurately able to predict the failure of conservative treatment.
Shirazi
Mehdi
M
Department of Urology, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Sefidbakht
Sepideh
S
Jahanabadi
Zahra
Z
Asadolahpour
Ardalan
A
Afrasiabi
Mohammad Amin
MA
D000293:Adolescent; D000328:Adult; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000628:therapy; D055815:Young Adult