Login to Access Video or Poster Abstract: MP79-19
Sources of Funding: none

Introduction

High grade renal injuries are usually diagnosed in multitrauma patients following traffic accidents, assault or penetrating trauma. In recent years, conservative management in hemodynamically stable patients is the preferred strategy. The primary aim of the study was to compare the characteristics of ambulatory Grade IV – V trauma patients (Group A) with patients transferred by prehospital emergency units (Group B).

Methods

Data were retrieved from emergency cases presented between 2000 and 2015. Rec-ords were reviewed for all patients hospitalised after a diagnosed renal injury. Trauma resulted from motor accidents, assault and falls. The same mode of diagnostic evalua-tion (clinical assessment, laboratory tests and radiographic staging) was followed in all patients. They were reviewed with respect to type of injury, age, gender, time of ac-ceptance from injury, physical and radiographic findings, renal function, associated injuries, comorbidities and outcome. All hemodynamically stable patients were selected for non-operative managed and were supported under close monitoring.

Results

One hundred and twenty-six patients (mean age: 44 years) were diagnosed with a Grade IV – V renal injury. Group B patients (n:102) had lower hemoglobin (9.5g/dl vs 13.5g/dl) and Glascow Coma Scale (8 vs 14) at presentation and higher ISS (21 vs 13). Renal injuries in Group A patients were due to falls and contact sports while most Group B patients (90%) had traffic accidents. Age, gender and radiographic findings were similar in both groups. Hematuria and pain were the main complains in Group A patients (n:24) who were admitted with 6 hours delay after the injury, did not have seri-ous associated injuries, were hospitalized for a mean of 4 days and only 2 had surgical intervention resulting in nephrectomy. Most Group B patients (80%) had multiple inju-ries and 70% had an early exploration resulting in 60 nephrectomies and 10 renal unit reconstructions. Genitourinary related complications included transient renal insuffi-ciency (9%), abscess formation (3%), and reoperation were observed in Group B pa-tients while coagulopathy (25%), respiratory infections (30%) and gastrointestinal dis-orders (52%) were similar in both groups. No late deaths were reported. Most patients were lost at long term follow up.

Conclusions

Ambulatory patients with high grade renal injury have minor signs and symptoms, not serious associated injuries and a better prognosis in regard of conservative manage-ment and outcome.

Funding

none