Tomasz Ząbkowski, Piotr Piasecki, Ryszard Skiba, Marek Saracyn
Urology Department.
Department of Interventional Radiology.
Medicine (Baltimore). 2019 Apr;98(14):e15135. doi: 10.1097/MD.0000000000015135.
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.
本研究的目的是确定肾外伤患者重复进行随访计算机断层扫描成像的必要性。确定了2008年1月至2017年12月在军事医学研究所创伤中心收治的所有诊断为肾损伤的患者。对所有患者的病历和放射影像进行了回顾性分析。收集了以下因素的数据——患者的人口统计学资料、创伤机制、美国创伤外科协会肾损伤分级、损伤严重程度评分、实验室检查、多器官损伤、新鲜冰冻血浆和浓缩红细胞输注情况、多器官损伤时的手术时间、住院时间以及急性肾损伤情况。该组包括37例左肾损伤患者、32例右肾损伤患者和5例双侧肾损伤患者。45例患者因机动车事故继发钝性损伤导致肾外伤，14例因高处坠落，4例因殴打致伤，1例因体育相关活动致伤，10例因其他因素致伤。在63例因多器官创伤或单纯创伤接受保守治疗的患者中，所有患者的形态学、血清肌酐和血尿素氮值以及超声检查均未显示早期肾损伤有任何病理变化。美国创伤外科协会分级为I-IV级的肾损伤保守治疗效果良好，仅涉及非侵入性超声检查。本研究证实，对于I-IV级肾损伤患者，只要其临床状态良好，可安全省略常规随访计算机断层扫描成像。
