PREDICTORS OF INTERVENTION IN PATIENTS OF RENAL TRAUMA TREATED PRIMARILY WITH CONSERVATIVE MANAGEMENT

Abstract

Background: Surgical intervention in patients of renal trauma is associated with a high rate of renal loss, with its long term sequelae of renal insufficiency. Expectant management of stable patients yields a lower rate of nephrectomy without a significant increase in the complication rate.

Objective: To study predictors of intervention in patients of renal trauma treated primarily with conservative management, admitted in the tertiary care hospital SKIMS Soura between the study period, 2012 to 2019.

Material and Methods: During the study period, 90 hemodynamically stable, properly staged renal trauma patients were included in the study group, and initially managed non operatively. Patients were observed for hemodynamic stability, serial hematocrit, transfusion requirement and development of any complication. Patients requiring further intervention in the form of Surgical, Radiological or Endourological Intervention, were further assessed to determine predictors of intervention.

Results: In our study; out of the 90 patients, 63(70%) were male and 27(30%) were female. mean age was 35.55 years (±10.10 SD). All patients with Grade I-III injury were managed non operatively, among the 32 patients with Grade IV injury 18(56.25%) patients were managed non operatively and 14(43.75%) patients required operative intervention. All 13 patients with Grade V injury required operative intervention. All patients with grade IV and grade V renal injury, with active contrast extravasation on CECT, underwent operative intervention.

Conclusion: Hemodynamic status at presentation, AAST organ injury severity scale, CECT characteristic of active contrast extravasation significantly predict the failure of non operative management and need for intervention in renal trauma.