title: Management trends, angioembolization performance and multiorgan injury indicators of renal trauma from Japanese administrative claims database.
abstract: OBJECTIVE
  To show the characteristics and therapeutic trends of renal trauma in Japan using a nationwide database.
  
  
  METHODS
  All renal trauma cases from the Diagnosis Procedure Combination database during 6 months of each year from 2006 to 2008 were included in the analysis. The following variables were considered: demographics, ambulance use, comorbid trauma, interventions, mechanism of injury and the Abbreviated Injury Scale. Patients were divided into two groups by trauma range: limited to rib, abdomen and pelvis (group A) or more extended (including supradiaphragmatic regions or lower extremities; group B). Rib fracture impact was assessed as a predictor of comorbid organ trauma. The incidences of angioembolization failure and nephrectomy were also evaluated.
  
  
  RESULTS
  A total of 1505 renal trauma cases (1014 and 491 in groups A and B, respectively) were identified. Comorbid trauma in the liver, spleen and lumbar/pelvic fractures were 7.4%, 5.6% and 5.1% in group A and 24.0%, 11.2% and 17.5% in group B, respectively. The rates of angioembolization (and its failure proportion), nephrectomy, transfusion and mortality were 7.9% (12.5%), 3.3%, 15.6% and 1.1% in group A, and 17.1% (11.9%), 2.6%, 28.3% and 8.1% in group B, respectively. Risks of coincident traumas in the liver, spleen and pelvic fracture were 2.23, 2.35 and 2.72 times higher if a rib fracture was observed. The incidences of renal trauma and nephrectomy (per 100 000 person-years) were estimated as 2.06 and 0.063, respectively.
  
  
  CONCLUSIONS
  Angioembolization failure is not rare, and nephrectomy is an important last resort. Patients with comorbid rib fracture should be explored for coincident traumas.
authors.affiliation: Department of Urology, Shintoshi Hospital, Iwata, Japan. ezy04707@nifty.com
authors.forename: Toru
authors.initials: T
authors.lastname: Sugihara
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nishimatsu
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukuhara
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Enomoto
authors.forename: Haruki
authors.initials: H
authors.lastname: Kume
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Ohe
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuda
authors.forename: Yukio
authors.initials: Y
authors.lastname: Homma
mesh_terms: D015998:Abbreviated Injury Scale; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D007668:Kidney / Q000293:injuries*; D008099:Liver / Q000293:injuries; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000453:epidemiology / Q000628:therapy; D009392:Nephrectomy / Q000706:statistics & numerical data; D012253:Rib Fractures / Q000453:epidemiology; D018570:Risk Assessment; D013154:Spleen / Q000293:injuries; D055815:Young Adult