Department of Urology, NYU Langone Hospital-Brooklyn, Brooklyn, NY, USA.
Department of Population Health, NYU Langone Hospital-Brooklyn, Brooklyn, NY, USA; Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA.
Eur Urol Focus. 2019 Nov;5(6):1135-1142. doi: 10.1016/j.euf.2018.06.006. Epub 2018 Jun 20.
Renal trauma may be managed differently in tiered trauma systems and among those who requireinterfaculty transfer.
To evaluate the initial management of renal trauma, assess patterns of management based on hospital trauma level designation and interfacility transfer status, and analyze management trends over time.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of renal trauma from the National Trauma Data Bank 2010-2015.
Nephrectomy, angioembolization, or nonoperative management.
We used generalized estimating equations to compare odds of each management outcome in patients transferred and directly admitted to a level I center, versus those directly admitted to a non-level I center, adjusting for vital signs, injury, demographic, and facility characteristics. We also used generalized estimating equations to examine linear time trends in management outcome, adjusting for injury characteristics.
A total of 51798 renal trauma records were included: 44 838 low-grade (American Association for the Surgery of Trauma I-III) and 6359 high grade (IV-V) injuries. After adjusting for comorbidities, demographics, and hospital characteristics, odds of nephrectomy, angioembolization, and nonoperative management were similar in patients transferred or directly admitted to a level I center compared with those treated at a non-level I center. Changes in management over time demonstrated a decreased rate of nephrectomy (p=0.007) in high-grade injuries, while the rate of angioembolization remained constant (p=0.33). Study limitations include mortality prior to hospital transfer or arrival, and its retrospective nature.
In this contemporary trauma analysis, outcomes of both low- and high-grade renal trauma are similar across patients managed in tiered trauma centers and those undergoing transfer, signifying dissemination of collective renal trauma management. The rate of nephrectomy has decreased for high-grade renal injury over our study period, suggesting new adoption of kidney-sparing management.
Renal trauma is now managed similarly in tiered trauma centers and in patients requiring interfacility transfer. The rate of nephrectomy for high-grade renal injuries has decreased over time.
在分级创伤系统和需要院内转科的患者中，肾创伤的处理可能存在差异。
评估肾创伤的初始处理，根据医院创伤级别和院内转科状态评估处理模式，并分析随时间的管理趋势。
设计、地点和参与者：回顾性队列研究，纳入 2010-2015 年国家创伤数据库中的肾创伤患者。
肾切除术、血管栓塞术或非手术治疗。
使用广义估计方程比较了转院至 I 级中心和直接收入 I 级中心的患者与直接收入非 I 级中心的患者的每种治疗结局的比值比，调整了生命体征、损伤、人口统计学和设施特征。我们还使用广义估计方程检查了治疗结局的线性时间趋势，调整了损伤特征。
共纳入 51798 例肾创伤记录：44838 例低级别（美国外科创伤协会 I-III 级）和 6359 例高级别（IV-V 级）损伤。调整合并症、人口统计学和医院特征后，与在非 I 级中心治疗的患者相比，转院或直接收入 I 级中心的患者接受肾切除术、血管栓塞术和非手术治疗的可能性相似。随着时间的推移，管理方式发生了变化，高级别损伤中肾切除术的比率降低（p=0.007），而血管栓塞术的比率保持不变（p=0.33）。研究的局限性包括在医院转院或到达前的死亡率及其回顾性性质。
在这项当代创伤分析中，在分级创伤中心管理的低级别和高级别肾创伤患者的结局相似，这表明肾创伤的整体管理得到了普及。在研究期间，高级肾损伤的肾切除术比率下降，表明新的保肾治疗方法的采用。
在分级创伤中心和需要院内转科的患者中，肾创伤的处理现在相似。随着时间的推移，高级肾损伤的肾切除术比率下降。
