Conservative Management of Major Blunt Renal Trauma with Extravasation: A Viable Option?

Elashry, Osama; Dessouky, Basma
April 2009
European Journal of Trauma & Emergency Surgery;Apr2009, Vol. 35 Issue 2, p115
Academic Journal
To evaluate our experience in the management of patients with major blunt renal trauma treated at a major urban trauma center during the last ten years. The medical records of 72 patients with major blunt renal lacerations treated from 1998 to 2008 were reviewed retrospectively. Patients were broken down into two groups based on whether they were managed conservatively (group 1) or surgically (group 2). Each group was compared with respect to the initial evaluation, computerized tomography findings, associated injuries, hospital stay, transfusion requirements, nephrectomy rate, complications and follow-up imaging. There were 57 patients with grade IV and 15 patients with grade V renal injuries. Of these, 51 (70.8%) patients were managed conservatively (48 with grade IV and 3 with grade V) and 21 (29.2%) patients were managed surgically (9 with grade IV and 12 with grade V). Patients in group 1 had significantly lower transfusion requirements (3.1 vs. 7.5 units, p < 0.0001), shorter hospital stays (11.8 vs. 15.9 days p < 0.003) and fewer complications (21.6 vs. 76.1%, p < 0.001). No death was observed in group 1, while three in group 2 died of major associated injuries. All surviving patients had significant resolution of the extravasation before hospital discharge. Our data supports the conservative management of grade IV blunt renal parenchymal injuries in the absence of hemodynamic instability of renal origin. Even select patients with grade V parenchymal injuries can undergo a trial of conservative management.


Related Articles

  • Integrated hospital emergency care improves efficiency. Boyle, A. A.; Robinson, S. M.; Whitwell, D.; Myers, S.; Bennett, T. J. H.; Hall, N.; Haydock, S.; Fritz, Z.; Atkinson, P. // Emergency Medicine Journal;Feb2008, Vol. 25 Issue 2, p78 

    Background: There is uncertainty about the most efficient model of emergency care. An attempt has been made to improve the process of emergency care in one hospital by developing an integrated model. Methods: The medical admissions unit was relocated into the existing emergency department and...

  • Reassess Boarders, or Risk Bad Outcomes and Lawsuits. Goehlert, Uwe G. // ED Legal Letter;Apr2012, Vol. 23 Issue 4, p45 

    The article discusses the legal risks that could confront emergency physicians (EP) in U.S. hospitals over the issue of patient boarding in emergency departments (ED). According to South Burlington, Vermont-based Goehlert & Associates' Uwe G. Goehlert, the practice places EPs in risky situations...

  • People with mental ill health have 'striking' disparity in use of emergency care.  // British Journal of Hospital Medicine (17508460);Nov2015, Vol. 76 Issue 11, p622 

    The article reports the high rates of emergency hospital admissions of mentally ill patients compared to patients with no mental illness in Great Britain in 2014, according to a study from the Nuffield Trust and Health Foundation.

  • Save Thousands By Reporting Hospital Discharge Correctly.  // Medicare Compliance & Reimbursement;Dec2012, Vol. 38 Issue 24, p185 

    The article outlines the five mistakes to avoid when reporting discharge services in the U.S. It indicates that several physicians might be managing the care of a patient, but only the attending physician should bill for the discharge. It says that sometimes a patient may not be eligible for a...

  • Use of an admission early warning score to predict patient morbidity and mortality and treatment success. Groarke, J. D.; Gallagher, J.; Stack, J.; Aftab, A.; Dwyer, C.; McGovern, R.; Courtney, G. // Emergency Medicine Journal;Dec2008, Vol. 25 Issue 12, p803 

    Background: Early warning scores (EWS) are used to identify physiological deterioration in patients. Studies to date have primarily focused on the correlation between trends in serially recorded EWS of inpatients and clinical outcomes. This study examined the predictive value of an EWS...

  • ED Navigators prevent unnecessary admissions.  // Hospital Case Management;Feb2012, Vol. 20 Issue 2, p22 

    The article discusses that nurse case managers at Montefiore Medical Center in Bronx, New York, also act as patient navigators in the emergency department (ED) and work closely with ED social workers to prevent unnecessary admissions. The program identifies patients with insubstantial living...

  • Discharged ED patients boarded.  // ED Management;Jul2009, Vol. 21 Issue 7, p78 

    The article discusses a hospital policy used by Vincent Hospital in Boston to address overcrowding of the emergency department with boarding patients in hallways. According to the policy, patients are only boarded if they have been discharged or about to be discharged. Director of emergency...

  • Development of a Real-Time General Medicine 30-Day Readmissions Notification System. Bae, Jonathan; Owens, Thomas; Ferranti, Jeffrey M.; Gilbert, William; Stashko, Ilona; Willis, Elizabeth; Barros, Tanya; Horvath, Monica M. // Journal of Hospital Administration;Feb2013, Vol. 2 Issue 1, p28 

    Hospital readmissions present a costly problem for healthcare systems. Engaging care providers in reviewing readmissions may reveal opportunities for reducing readmissions and improving quality. We developed a real-time alerting method that e-mails providers when a discharged patient returns for...

  • In brief.  // Nursing Children & Young People;Jul2011, Vol. 23 Issue 6, p5 

    This section offers world news briefs related to health care as of July 2011 including one on the election of consultant editor Doreen Crawford as chair of the children and young people's acute care forum of the Royal College of Nursing (RCN), one on the effects of passive smoking on infants,...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics