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Renal Injury and Operative Management in the United States: Results of a Population-Based Study

Wessells, Hunter MD; Suh, Donald MD; Porter, James R. MD; Rivara, Frederick MD, PhD; MacKenzie, Ellen J. PhD; Jurkovich, Gregory J. MD; Nathens, Avery B. MD, PhD, MPH

Journal of Trauma-Injury Infection & Critical Care: March 2003 - Volume 54 - Issue 3 - pp 423-430
Original Articles

Background : To evaluate the extent to which nonoperative renal trauma management has been adopted, we determined the incidence of renal injury and the rate of operative management across the United States.

Methods : International Classification of Diseases, Ninth Revision diagnosis and procedure codes identified patients with renal injuries in an 18-state administrative database representing 62% of the U.S. population.

Results : Of 523,870 patients hospitalized for trauma in 1997 or 1998, 6,231 (1.2%) had renal injuries (4.89 per 100,000 population). Sixty-four percent of patients with injuries that were classified had contusions/hematomas, 26.3% had lacerations, 5.3% had parenchymal disruption, and 4% had vascular injuries. Eleven percent of renal trauma patients required surgical management of their kidney injuries, of whom 61%, or 7% of patients with renal injuries overall, underwent nephrectomy. Injury Severity Score, mechanism, and renal injury severity were independent predictors of nephrectomy.

Conclusion : The nephrectomy rate in community and academic centers reflects renal and global injury severity. Prospective trials are indicated to determine whether, in the traumatized patient with severe kidney injury, renal preservation could lead to improved outcomes compared with nephrectomy.

From the Departments of Urology (H.W., D.S., J.R.P.), Pediatrics (F.R.), and Surgery (G.J.J., A.B.N.), Harborview Medical Center and University of Washington School of Medicine, and the Harborview Injury Prevention Research Center (H.W., F.R., G.J.J., A.B.N.), Seattle, Washington, and School of Public Health (E.J.M.), Johns Hopkins University, Baltimore, Maryland.

Submitted for publication October 8, 2002.

Accepted for publication November 24, 2002.

Presented at the 62nd Annual Meeting of the American Association for the Surgery of Trauma, September 26–28, 2002, Orlando, Florida.

Address for reprints: Hunter Wessells, MD, FACS, Department of Urology, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104; email: wessells@u.washington.edu.

© 2003 Lippincott Williams & Wilkins, Inc.