Validity of routine reimaging of blunt renal trauma managed conservatively

Abstract

The purpose of this study was to determine the need of repeat follow-up computed tomography imaging in patients with renal trauma.

All patients who were admitted in the trauma center of the Military Institute of Medicine with a diagnosis of kidney injury from January 2008 to December 2017 were identified. A retrospective review of all patients’ medical records and radiologic imaging was conducted.

Data on the following factors were collected – patients’ demographics, mechanism of trauma, American Association for the Surgery of Trauma renal injury scale, injury severity score, laboratory examinations, multiorgan injuries, transfusion of fresh frozen plasma and packed red blood cells, time of surgical procedure in multiorgan injuries, length of hospital stay, and acute kidney injury.

This group consisted of 37 patients with left renal injuries, 32 with right renal injuries, and 5 with bilateral renal injuries. Renal trauma due to blunt injury secondary to a motor vehicle accident was noted in 45 patients, falling from a height in 14 patients, injury from battery in 4 patients, sports-related activities in 1 patient, and other factors in 10 patients.

Of the 63 patients treated conservatively due to multiorgan trauma or isolated trauma, values of morphology, serum creatinine and blood urea nitrogen, and ultrasonography in all patients did not reveal any pathological changes within earlier kidney damage.

The conservative treatment of grade I-IV renal injury in the American Association for the Surgery of Trauma scale provided good outcome and only involved noninvasive ultrasonography.

This study confirms that routine follow-up computed tomography imaging can be safely omitted in renal injuries graded I-IV providing that the patient remains in good clinical state.