title: Comparison of nonoperative and surgical management of renal trauma: Can we predict when nonoperative management fails?
abstract: Limited data exist on risk factors for the failure of nonoperative management of renal trauma. Our study objective was to determine the incidence, salvage procedure, and risk factors for failure of nonoperative management of renal trauma.
  
  
  
  The National Trauma Data Bank research data sets for admission years 2010-2014 were queried for renal injury by Abbreviated Injury Score code. Patients were stratified by interventional therapy (renal procedure code <24 hours from admission) and nonoperative management (no surgical renal procedure <24 hours). Abbreviated Injury Score was converted to American Association for the Surgery of Trauma renal injury grade. Demographics, patient and injury characteristics were compared between groups using stratified analysis. Multivariable logistic regression models were used to determine variables that were associated with failure of nonoperative management.
  
  
  
  A review of 3,977,634 cases revealed 19,572 renal injuries that met study criteria. A total of 16.6% were managed with interventional therapy, and 83.4% were managed nonoperatively, of which 2.7% failed nonoperative management. Risk-adjusted multivariate regression indicated that penetrating injury (stab: odds ratio [OR], 1.61; 95% confidence interval [CI], 1.02-2.53 [p = 0.040]; and gunshot wound: OR, 1.40; 95% CI, 1.04-1.90 [p = 0.029]), highest abdominal injury grade for nonrenal organs (OR, 2.06; 95% CI, 1.65-2.57), and highest renal injury grade (OR, 1.85; 95% CI, 1.54-2.21) were associated with failure of nonoperative management (all p < 0.001). Increasing injury grades were associated with increasing risk of failing nonoperative management (Grade III: OR, 1.94; 95% CI, 1.35-2.90; Grade IV: OR, 9.79; 95% CI, 7.04-13.63; and Grade V: OR, 9.45; 95% CI, 6.02-14.86 [all p < 0.001]).
  
  
  
  Nonoperative management in the first 24 hours after fails in up to 2.7%. Renal injury grade, nonrenal abdominal injuries, and penetrating injuries predict for nonoperative management failure. Highest-grade renal injuries are at increased risk of failure.
  
  
  
  Prognostic/epidemiologic study, level III; therapeutic study, level IV.
authors.affiliation: From the Division of Urology, Department of Surgery, NYU Lutheran Medical Center, NYU Langone Health System, NYU School of Medicine, New York, New York (M.A.B.); Section of Urology, Department of Surgery, The University of Chicago, Chicago, Illinois (R.J.F.); Department of Surgery, Section of Trauma, and Surgical Critical Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois (R.J.F); and Department of Research, Advocate Illinois Masonic Medical Center, Chicago, Illinois (D.V.).
authors.forename: Marc A
authors.initials: MA
authors.lastname: Bjurlin
authors.forename: Richard Jacob
authors.initials: RJ
authors.lastname: Fantus
authors.forename: Richard Joseph
authors.initials: RJ
authors.lastname: Fantus
authors.forename: Dana
authors.initials: D
authors.lastname: Villines
mesh_terms: D015998:Abbreviated Injury Scale; D000007:Abdominal Injuries / Q000601:surgery / Q000628:therapy*; D000328:Adult; D002170:Canada; D005260:Female; D006801:Humans; D007668:Kidney / Q000293:injuries*; D008297:Male; D009392:Nephrectomy; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D014193:Trauma Centers; D017211:Treatment Failure; D014481:United States