title: High-grade renal injuries are often isolated in sports-related trauma.
abstract: BACKGROUND
  Most high-grade renal injuries (American Association for Surgery of Trauma (AAST) grades III-V) result from motor vehicle collisions associated with numerous concomitant injuries. Sports-related blunt renal injury tends to have a different mechanism, a solitary blow to the flank. We hypothesized that high-grade renal injury is often isolated in sports-related renal trauma.
  
  
  METHODS
  We identified patients with AAST grades III-V blunt renal injuries from four level 1 trauma centres across the United States between 1/2005 and 1/2014. Patients were divided into "Sport" or "Non-sport" related groups. Outcomes included rates of hypotension (systolic blood pressure <90mm Hg), tachycardia (>110bpm), concomitant abdominal injury, and procedural/surgical intervention between sports and non-sports related injury.
  
  
  RESULTS
  320 patients met study criteria. 18% (59) were sports-related injuries with the most common mechanisms being skiing, snowboarding and contact sports (25%, 25%, and 24%, respectively). Median age was 24 years for sports and 30 years for non-sports related renal injuries (p=0.049). Males were more commonly involved in sports related injuries (85% vs. 72%, p=0.011). Median injury severity score was lower for sports related injuries (10 vs. 27, p<0.001). There was no difference in renal abbreviated injury scale scores. Sports related trauma was more likely to be isolated without other significant injury (69% vs. 39% (p<0.001)). Haemodynamic instability was present in 40% and 51% of sports and non-sports renal injuries (p=0.30). Sports injuries had lower transfusion (7% vs. 47%, p<0.001) and lower mortality rates (0% vs. 6%, p=0.004). There was no difference in renal-specific procedural interventions between the two groups (17% sports vs. 18% non-sports, p=0.95).
  
  
  CONCLUSIONS
  High-grade sports-related blunt renal trauma is more likely to occur in isolation without other abdominal or thoracic injuries and clinicians must have a high suspicion of renal injury with significant blows to the flank during sports activities.
authors.affiliation: Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, United States. Electronic address: Darshan.Patel@utah.edu.
authors.forename: Darshan P
authors.initials: DP
authors.lastname: Patel
authors.affiliation: Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, United States.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Redshaw
authors.affiliation: Department of Urology, University of California San Francisco, San Francisco, CA, United States.
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Breyer
authors.affiliation: Department of Urology, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Smith
authors.affiliation: Department of Urology, University of Iowa Carver College of Medicine, Iowa City, IA, United States.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Erickson
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, Intermountain Medical Center, Murray, UT, United States.
authors.forename: Sarah D
authors.initials: SD
authors.lastname: Majercik
authors.affiliation: Department of Urology, University of California San Francisco, San Francisco, CA, United States.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Gaither
authors.affiliation: Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, United States.
authors.forename: James R
authors.initials: JR
authors.lastname: Craig
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, Intermountain Medical Center, Murray, UT, United States.
authors.forename: Scott
authors.initials: S
authors.lastname: Gardner
authors.affiliation: Division of Epidemiology, University of Utah, Salt Lake City, UT, United States.
authors.forename: Angela P
authors.initials: AP
authors.lastname: Presson
authors.affiliation: Division of Epidemiology, University of Utah, Salt Lake City, UT, United States.
authors.forename: Chong
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, United States.
authors.forename: James M
authors.initials: JM
authors.lastname: Hotaling
authors.affiliation: Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, United States.
authors.forename: William O
authors.initials: WO
authors.lastname: Brant
authors.affiliation: Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, United States.
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: Myers
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D001265:Athletic Injuries / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007668:Kidney / Q000293:injuries*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control
keywords: Abdominal injuries; Kidney; Non-penetrating; Snow sports; Sports; Wounds