Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar 17:14:79-85.
doi: 10.2147/RRU.S349504. eCollection 2022.

Implementation of a Standardized Renal Trauma Protocol at a Level 1 Trauma Center: 7-Year Protocol and 10-Year Institutional Review

Zachary Werner  1 , Ahmad Haffar  2 , Emma Bacharach  1 , Jennifer Knight-Davis  3 , Ali Hajiran  1 , Adam Luchey  1
Affiliations

Implementation of a Standardized Renal Trauma Protocol at a Level 1 Trauma Center: 7-Year Protocol and 10-Year Institutional Review

Zachary Werner et al. Res Rep Urol. .

Abstract

Objective: Current urologic renal trauma guidelines favor conservative management. In 2012, we implemented an institution-wide renal trauma protocol to standardize management. This protocol details initiation of DVT (deep vein thrombosis) prophylaxis, cessation of bed rest, and frequency of laboratory studies. We hypothesized that low-grade injuries (grade I-III) could be managed without urologic consultation and that our chemical DVT prophylaxis regimen would not pose an increased risk of hemorrhage requiring transfusion.

Methods: We performed a cross-sectional analysis of a prospectively maintained database containing all renal trauma at our institution from 2009 to 2019. We segregated injuries based on grade, presence of multi-organ trauma, and evaluated the presence and types of intervention, initiation of chemical DVT prophylaxis, and post-DVT prophylaxis hemorrhage requiring transfusion.

Results: We identified 295 cases of renal trauma, of which 62 were isolated injuries. Forty-three of the isolated renal injuries were transferred from outside facilities, 70% of which were classified as low-grade injuries. There were 220 low-grade lacerations and 75 high-grade lacerations. No grade I or II lacerations required any interventions. Two (2.5%) grade III lacerations required IR embolization. Twenty-five (41%) grade IV lacerations required intervention, of which five were nephrectomy. Seven (54%) grade V lacerations required intervention, of which 5 were nephrectomies. Upon review of our protocol with early ambulation and DVT prophylaxis, there were no cases of isolated renal injury where initiation of either treatment resulted in delayed hemorrhage requiring transfusion or surgical intervention.

Conclusion: Only 2/220 low-grade renal lacerations required intervention. Our data suggest that grade I and II renal lacerations can be managed safely without urologic consultation. Consultation is warranted for grade III injuries given the possibility of initial understaging. Furthermore, we believe our renal laceration protocol in our admittedly small, isolated sample has shown our DVT prophylaxis initiation to not pose increased risk.

Keywords: protocol; renal; review; thromboembolic; trauma.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest in this work.

References

    1. Morey A, Brandes S, Dugi D, et al. Urotrauma: AUA guideline. J Urol. 2014;192(2):327–335. doi:10.1016/j.juro.2014.05.004 - DOI - PMC - PubMed
    1. Summerton DJ, Djakovic N, Kitrey ND, et al. Guidelines on urological trauma, limited update 2018. Available from: http://uroweb.org/guideline/urologicaltrauma/. Accessed December, 2020.
    1. Mccombie S, Thyer I, Corcoran N, et al. The conservative management of renal trauma: a literature review and practical clinical guideline from Australia and New Zealand. BJU Int. 2014;114(Suppl 1):13–21. doi:10.1111/bju.12902 - DOI - PubMed
    1. Malcolm J, Derweesh I, Mehrazin R, et al. Nonoperative management of blunt renal trauma: is routine early follow-up imaging necessary? BMC Urol. 2008;8:11. doi:10.1186/1471-2490-8-11 - DOI - PMC - PubMed
    1. Geerts W, Code K, Jay R, et al. A prospective study of venous thromboembolism after major trauma. N Engl J Med. 1994;331:1601–1606. doi:10.1056/NEJM199412153312401 - DOI - PubMed