UROGENITAL TRAUMA

Management and Hospital Outcomes of Blunt Renal Artery Injuries: Analysis of 517 Patients from the National Trauma Data Bank
Sangthong B, Demetriades D, Martin M, Salim A, Brown C, Inaba K, Rhee P, Chan L
Division of Trauma and Critical Care, Department of Surgery, School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
J Am Coll Surg. 2006; 203: 612-7

• Background: Blunt renal artery injuries are rare and no single trauma center can accumulate substantial experience for meaningful conclusions about optimal therapeutic strategies. The purpose of this study was to assess the incidence of renal artery injuries after different types of blunt trauma, and evaluate the current therapeutic approaches practiced by American trauma surgeons and the effect of various therapeutic modalities on hospital outcomes.
• Study Design: This was a National Trauma Data Bank study including all blunt trauma admissions with renal artery injuries. Demographics, mechanism of injury, Injury Severity Score, Abbreviated Injury Score for each body area (head, chest, abdomen, extremities) injuries, type of management (nephrectomy, arterial reconstruction, or observation), time from admission to definitive treatment, and hospital outcomes (mortality, ICU, and hospital stay) were analyzed. Multiple and logistic regression analyses were used to examine the relationship between type of management and hospital outcomes.
• Results: Of a total of 945,326 blunt trauma admissions, 517 patients (0.05%) had injuries to the renal artery. Of the 517 patients, the kidney was not explored in 376 (73%), 95 (18%) patients had immediate nephrectomy, and 45 (9%) patients underwent surgical revascularization. In 87 of 517 (17%) patients, renal artery injury was the only intraabdominal injury. Of the 87 patients with isolated renal artery injuries, 73 (84%) were observed, 7 (8%) underwent surgical revascularization, and 7 (8%) had early nephrectomy. Multiple regression analysis demonstrated that patients who had surgical revascularization had a considerably longer ICU and hospital stay than observed patients. Patients who had nephrectomy had a considerably longer hospital stay than observed patients.
• Conclusions: Blunt renal artery injury is rare. Nonoperative management should be considered as an acceptable therapeutic option.
  
  
• Editorial Comment
  The National Trauma Data Bank (NTDB) is a very useful and powerful database tool for which one can perform outcomes research of urological trauma. Access to the data is free and can easily be accessed over the internet. The NTDB is a nation wide trauma registry from trauma centers across the United States and Puerto Rico, and contains over 2 million records. The goal of the NTDB is to inform the medical community, the public, and decision makers about a wide variety of issues that characterize the current state of care for injured persons. The information contained in the data bank has implications in many areas including epidemiology, injury control, research, education, acute care, and resource allocation. The NTDB is a very useful and powerful database tool for which one can perform outcomes research of urological trauma. Access to the data is free and easily accessed over the internet.
  As to blunt renal artery injuries that result in intimal injury and subsequent arterial thrombosis, Sangthong et al report on their review of renal injuries from across the US. Clearly, when there are two normal kidneys and the patient has normal renal function, renal artery thrombosis is best managed conservatively. Even when recognized promptly, exploration and renal artery repair is often not successful, and when successful, typically preservation of renal function is very poor. Exploration is indicated, however, in cases of injured solitary kidneys or in the very rare instance of bilateral renal artery thrombosis.

Dr. Steven B. Brandes
Associate Professor, Division of Urologic Surgery
Washington University in St. Louis
St. Louis, Missouri, USA
E-mail: brandess@wudosis.wustl.edu