J. Wycech1,2, J. Saluck1,3, A. Tymchak1,3, M. Crawford1,2, M. Gomez2, I. Puente1,2,3,4, A. A. Fokin1 1Delray Medical Center,Trauma Services,Delray Beach, FL, USA 2Broward Health Medical Center,Trauma Services,Fort Lauderdale, FL, USA 3Florida Atlantic University,College Of Medicine,Boca Raton, FL, USA 4Florida International University,College Of Medicine,Miami, FL, USA
Introduction:
In hemodynamically stable patients, nonoperative management (NOM) of blunt kidney injuries (BKI) has become the standard of care. However, the efficacy of NOM in patients with BKI combined with other solid organ injuries (SOI) remains unclear. The aim of this study was to assess the efficacy of NOM in isolated BKI as compared to combined BKI.
Methods:
This IRB approved retrospective cohort study included 74 adult patients, admitted to a level 1 trauma center between 2012 and 2017 with a kidney injury confirmed by computed tomography scan. 49 patients had an isolated BKI (Group I) and 25 patients had BKI combined with additional SOI (Group II). The most common additional SOI in Group II were equally distributed between the spleen and liver (56.0% each), followed by pancreas and adrenal glands (8.0% each). Injury Severity Score (ISS), mechanism of injury (MOI), kidney Organ Injury Scale (KOIS) grade, packed red blood cells transfused within 24 hours of admission (PRBC24), rates of hemoperitoneum, angiography, embolization, Intensive Care Unit length of stay (ICULOS), hospital LOS (HLOS) and mortality were compared.
Results:
Group I compared to Group II had statistically lower mean ISS (17.5 vs 24.0; p=0.02), also having less high impact MOI (61.2% vs 92.0%; p=0.02). Mean KOIS for both groups was similar, grade 2.2 for Group I and 2.3 for Group II (p=0.5). NOM was attempted in 98.0% of patients in Group I and in 80.0% of Group II (p=0.007). Attempted NOM was successful in 100% of Group I and in 85.0% of Group II (p=0.01). Of the 3 patients that failed NOM in Group II, 2 patients failed due to a liver injury and 1 due to a spleen injury. In Group I, 1 patient underwent an early exploratory laparotomy and surgical intervention on the kidney. Early exploratory laparotomy was performed less often in Group I compared to Group II (2.0% vs 20.0%; p<0.001), with 40.0% undergoing surgery of the kidney and 60.0% surgery of other organs only.
Rate of PRBC24 was statistically lower in Group I than in Group II (16.0% vs 24.0%; p=0.004). Hemoperitoneum was detected statistically less often in Group I than in Group II (45.0% vs 72.0%; p=0.003). Angiography was performed statistically less often in Group I than in Group II (8.2% vs 36.0%; p=0.003), as was embolization (0.0% vs 12.0%; p=0.01). ICULOS was similar for the two groups (6.5 vs 6.7 days, p=0.3), however HLOS was statistically shorter in Group I than in Group II (8.2 vs 10.9 days; p=0.04). Mortality rate was not statistically different between two groups (12.2% vs 8.0%; p=0.6) and none of it was attributed to the kidney injury.
Conclusion:
In Group I, attempted NOM was always successful, regardless of severity of kidney injury. However, in Group II, attempted NOM was statistically less successful, due to the other organ injuries. In patients with combined BKI, the consideration of NOM should not be based on the severity of the kidney injury but instead should be based on the severity of other SOI.