J. Saluck1,2, M. Crawford2, A. A. Fokin2, A. Tymchak1,2,3, J. Wycech2,3, M. Gomez3, I. Puente1,2,3,4 1Florida Atlantic University,College Of Medicine,Boca Raton, FL, USA 2Delray Medical Center,Trauma Services,Delray Beach, FL, USA 3Broward Health Medical Center,Trauma Services,Fort Lauderdale, FL, USA 4Florida International University,College Of Medicine,Miami, FL, USA
Introduction:
Nonoperative management (NOM) is the standard of care in majority of blunt kidney injuries (BKI). However, little is known about the effect of age on outcomes of NOM. The aim of this study was to assess the efficacy of NOM in BKI in geriatric vs non-geriatric patients.
Methods:
This IRB approved retrospective cohort study included 86 adult patients, admitted to a level 1 trauma center between 2012 and 2017 with computed tomography (CT) confirmed kidney injuries. 49 patients had isolated BKI, 25 BKI with other solid organ injuries, 9 BKI plus hollow viscus injury and 3 BKI plus abdominal vascular injuries. Patients were separated into 2 groups: Group I ≥65 years old (n=21) and Group II <65 years old (n=65). Age, Injury Severity Score (ISS), kidney organ injury scale (OIS) grade, comorbidities, packed red blood cells transfused within 24 hours of admission (PRBC24), rates of hemoperitoneum, angiography, embolization, Intensive Care Unit length of stay (ICULOS), hospital length of stay (HLOS) and mortality were compared.
Results:
Mean age in Group I was 82.2 vs 36.8 years in Group II (p<0.001). The two groups had similar mean ISS (19.0 vs 22.4; p=0.4) and the same mean OIS grade of 2.3 (p=0.8). Group I had statistically more comorbidities than Group II (90.5% vs 60.0%; p=0.01). Main comorbidities in Group I included hypertension, anticoagulation therapy prior to trauma (p<0.001), and cardiovascular disease. Main comorbidities in Group II included hypertension, obesity, and substance abuse.
NOM was attempted in 100% of Group I patients and in 76.9% of Group II patients (p=0.02). The frequency of attempted NOM was lower in Group II due to higher prevalence of other abdominal injuries. For attempted NOM patients in Groups I and II, mean ISS (19.0 vs 18.1, p=0.9) and OIS grade (2.3 vs 2.1, p=0.7) were similar, which adds to the comparability of the groups. Attempted NOM was successful in 100% of Group I patients and in 93.8% of Group II (p=0.3). Of the 3 patients that failed NOM in Group II, 2 patients failed due to a liver injury and 1 patient due to a spleen injury.
For both groups rates of PRBC24 (33.3% vs 41.5%), hemoperitoneum (52.4% vs 61.5%), angiography (9.5% vs 18.5%), embolization (4.8% vs 4.6%), ICULOS (5.9 vs 7.4 days) and HLOS (8.1 vs 10.5 days) were similar (p>0.4). Group I tended to have higher mortality than Group II (19.0% vs 10.8%; p=0.3) but it did not reach statistical significance. Concomitant traumatic brain injury was the leading cause of mortalities in Groups I and II, at 50.0% and 57.1% respectively. None of the mortality in either group was due to the kidney injury.
Conclusion:
Even with more comorbidities, the advanced age was not a contraindication for NOM and did not affect the success of NOM in geriatric patients with BKI. The severity of kidney injury in both age groups was similar and did not affect the frequency of attempted NOM.