title: The need for early angiography in patients with penetrating renal injuries.
abstract: BACKGROUND
  Renal injuries occur in as many as 10% of penetrating abdominal wounds. Today, these wounds are often managed selectively, but there is little contemporary information on the natural history of kidney injuries after penetrating trauma. The purpose of this study was to examine the clinical outcomes of penetrating injuries to the kidney, and to determine if these patients may benefit from routine early angiography.
  
  
  METHODS
  All trauma patients admitted to three Level I Trauma Centers with penetrating renal injuries over a 10 year study period were retrospectively reviewed.
  
  
  RESULTS
  We identified 237 patients with a penetrating renal injury, of whom 39 died within the first 24 h and were excluded from analysis. Among the remaining 198 individuals, 130 (66%) underwent immediate exploratory laparotomy. Of the 68 subjects not undergoing immediate surgery, seven had early angiography. The remaining 61 patients (31%) were observed, with 12 (20%) ultimately requiring an intervention to treat the renal injury. Those subjects who failed nonoperative management had significantly fewer hospital-free days compared to those who did not need a procedure (19.2 ± 8.1 vs. 25.7 ± 4.5, p = 0.002).
  
  
  CONCLUSIONS
  Nearly one in three patients with penetrating renal injuries are currently managed with serial observation, although one in five of these subjects ultimately require either angiographic or surgical treatment. We feel that routine use of early angiography may reduce the failure rate and improve outcomes for patients whose penetrating renal injuries are managed nonoperatively.
authors.affiliation: Department of Surgery, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
authors.forename: M T
authors.initials: MT
authors.lastname: Muir
authors.affiliation: Department of Surgery, University of Southern California School of Medicine, Los Angeles, CA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Inaba
authors.affiliation: Department of Surgery, Allegheny General Hospital, Pittsburgh, PA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Ong
authors.affiliation: Department of Surgery, University of Southern California School of Medicine, Los Angeles, CA, USA.
authors.forename: G
authors.initials: G
authors.lastname: Barmparas
authors.affiliation: Department of Surgery, University of Southern California School of Medicine, Los Angeles, CA, USA.
authors.forename: B C
authors.initials: BC
authors.lastname: Branco
authors.affiliation: Department of Surgery, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Zubowicz
authors.affiliation: Department of Surgery, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
authors.forename: M
authors.initials: M
authors.lastname: Salhanick
authors.affiliation: Department of Surgery, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA. cohn@uthscsa.edu.
authors.forename: S M
authors.initials: SM
authors.lastname: Cohn
keywords: Abdominal trauma; Urology
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