nach oben

Erschienen in:

28.06.2019 | Original Article

Early discharge in selected patients with low-grade renal trauma

verfasst von: Lucas Freton, Lucie-Marie Scailteux, Marine Hutin, Jonathan Olivier, Quentin Langouet, Marina Ruggiero, Ines Dominique, Clémentine Millet, Sébastien Bergerat, Paul Panayatopoulos, Reem Betari, Xavier Matillon, Ala Chebbi, Thomas Caes, Pierre-Marie Patard, Nicolas Szabla, Nicolas Brichart, Axelle Boehm, Laura Sabourin, Kerem Guleryuz, Charles Dariane, Cédric Lebacle, Jérome Rizk, Alexandre Gryn, François-Xavier Madec, François-Xavier Nouhaud, Xavier Rod, Emmanuel Oger, Gaelle Fiard, Karim Bensalah, Benjamin Pradere, Benoit Peyronnet, for the TRAUMAFUF Collaborative Group

Erschienen in: World Journal of Urology | Ausgabe 4/2020

Einloggen, um Zugang zu erhalten

Abstract

Introduction

The aim of this study was to assess whether early discharge could be non-inferior to inpatient management in selected patients with low-grade renal trauma (AAST grades 1–3).

Materials and methods

A retrospective national multicenter study was conducted including all patients who presented with renal trauma at 17 hospitals between 2005 and 2015. Exclusion criteria were iatrogenic and AAST grades 4 and 5 trauma, non-conservative initial management, Hb < 10 g/dl or transfusion within the first 24 h, and patients with concomitant injuries. Patients were divided into two groups according to the length of hospital stay: ≤ 48 h (early discharge), and > 48 h (inpatient). The primary outcome was “Intervention” defined as any interventional procedure needed within the first 30 days. A Stabilized Inverse Probability of Treatment Weighting (SIPTW) propensity score based binary response model was used to estimate risk difference.

Results

Out of 1764 patients with renal trauma, 311 were included in the analysis (44 in the early discharge and 267 in the inpatient group). In the early discharge group, only one patient required an intervention within the first 30 days vs. 10 in the inpatient group (3.7% vs. 5.2%; p = 0.99). Adjusted analysis using SIPTW propensity score showed a risk difference of − 2.8% [− 9.3% to + 3.7%] of “interventions” between the two groups meeting the non-inferiority criteria.

Conclusion

In a highly selected cohort, early discharge management of low-grade renal trauma was not associated with an increased risk of early “intervention” compared to inpatient management. Further prospective randomized controlled trials are needed to confirm these findings.

Nur mit Berechtigung zugänglich

Kitrey ND, Djakovic N, Kuehhas FE, Lumen N, Serafetinidis E, Sharma DM (2018) EAU guidelines. Urological trauma edn. Presented at the EAU annual congress Copenhagen 2018. ISBN 978-94-92671-04-2. http://uroweb.org/guideline/urological-trauma/. Accessed 15 June 2019

Matthews LA, Spirnak JP (1995) The nonoperative approach to major blunt renal trauma. Semin Urol 13(1):77–82PubMed

Keihani S, Xu Y, Presson AP, Hotaling JM, Nirula R, Piotrowski J, Dodgion CM et al (2018) Contemporary management of high-grade renal trauma: results from the American Association for the Surgery of Trauma Genitourinary Trauma study. J Trauma Acute Care Surg 84(3):418–425. https://doi.org/10.1097/TA.0000000000001796 CrossRefPubMed

Sujenthiran A, Elshout PJ, Veskimae E, MacLennan S, Yuan Y, Serafetinidis E, Sharma DM et al (2017) Is nonoperative management the best first-line option for high-grade renal trauma? A systematic review. Eur Urol Focus. https://doi.org/10.1016/j.euf.2017.04.011 CrossRefPubMed

Morey AF, Brandes S, Dugi DD, Armstrong JH, Breyer BN, Broghammer JA, Erickson BA et al (2014) Urotrauma: AUA guideline. J Urol 192(2):327–335. https://doi.org/10.1016/j.juro.2014.05.004 CrossRefPubMedPubMedCentral

Mahajerin A, Branchford BR, Amankwah EK, Raffini L, Chalmers E, van Ommen CH, Goldenberg NA (2015) Hospital-associated venous thromboembolism in pediatrics: a systematic review and meta-analysis of risk factors and risk-assessment models. Haematologica 100(8):1045–1050. https://doi.org/10.3324/haematol.2015.123455 CrossRefPubMedPubMedCentral

Instruction DGOS/R3 no 2010-457 du 27 décembre 2010 relative à la chirurgie ambulatoire: perspectives de développement et démarche de gestion du risque. NOR: ETSH1033647J. https://solidarites-sante.gouv.fr/fichiers/bo/2011/11-01/ste_20110001_0100_0114.pdf. Accessed 15 June 2019

Cirocchi R, Boselli C, Corsi A, Farinella E, Listorti C, Trastulli S, Renzi C et al (2013) Is non-operative management safe and effective for all splenic blunt trauma? A systematic review. Crit Care 17(5):R185. https://doi.org/10.1186/cc12868 CrossRefPubMed

Soo K-M, Lin T-Y, Chen C-W, Lin Y-K, Kuo L-C, Wang J-Y, Lee W-C, Lin H-L (2015) More becomes less: management strategy has definitely changed over the past decade of splenic injury—a nationwide population-based study. Biomed Res Int 2015:124969. https://doi.org/10.1155/2015/124969 CrossRefPubMedPubMedCentral

10.

Kozar Rosemary A, McNutt Michelle K (2010) Management of adult blunt hepatic trauma. Curr Opin Crit Care 16(6):596. https://doi.org/10.1097/MCC.0b013e32833f5cd5 CrossRefPubMed

11.

Swift C, Garner J (2012) Non-operative management of liver trauma. J R Army Med Corps 158(2):85–95. https://doi.org/10.1136/jramc-158-02-04 CrossRefPubMed

12.

van der Wilden GM, Velmahos GC, Joseph DK, Jacobs L, Debusk MG, Adams CA, Gross R et al (2013) Successful nonoperative management of the most severe blunt renal injuries: a multicenter study of the Research Consortium of New England Centers for Trauma. JAMA Surg 148(10):924–931. https://doi.org/10.1001/jamasurg.2013.2747 CrossRefPubMed

13.

Hampson LA, Radadia KD, Odisho AY, McAninch JW, Breyer BN (2018) Conservative management of high-grade renal trauma does not lead to prolonged hospital stay. Urology 115:92–95. https://doi.org/10.1016/j.urology.2017.11.018 CrossRefPubMedPubMedCentral

14.

Winters Brian, Wessells Hunter, Voelzke Bryan B (2016) Readmission after treatment of grade 3 and 4 renal injuries at a level 1 trauma center: statewide assessment using the comprehensive hospital abstract reporting system. J Trauma Acute Care Surg 80(3):466–471. https://doi.org/10.1097/TA.0000000000000948 CrossRefPubMedPubMedCentral

15.

Thall EH, Stone NN, Cheng DL, Cohen EL, Fine EM, Leventhal I, Aldoroty RA (1996) Conservative management of penetrating and blunt type III renal injuries. Br J Urol 77(4):512–517CrossRef

16.

London JA, Parry L, Galante J, Battistella F (2008) Safety of early mobilization of patients with blunt solid organ injuries. Arch Surg (Chicago, Ill.: 1960) 143(10):972–976. https://doi.org/10.1001/archsurg.143.10.972(discussion 977) CrossRef

17.

Wang E, Inaba K, Byerly S, Mendelsberg R, Sava J, Benjamin E, Lam L, Demetriades D (2017) Safety of early ambulation following blunt abdominal solid organ injury: a prospective observational study. Am J Surg 214(3):402–406. https://doi.org/10.1016/j.amjsurg.2017.05.014 CrossRefPubMed

18.

Dodgion CM, Gosain A, Rogers A, St. Peter SD, Nichol PF, Ostlie DJ (2014) National trends in pediatric blunt spleen and liver injury management and potential benefits of an abbreviated bed rest protocol. J Pediatr Surg 49(6):1004–1008. https://doi.org/10.1016/j.jpedsurg.2014.01.041 CrossRefPubMed

19.

Teichman A, Scantling D, McCracken B, Eakins J (2017) Early mobilization of patients with non-operative liver and spleen injuries is safe and cost effective. Eur J Trauma Emerg Surg. https://doi.org/10.1007/s00068-017-0864-9 CrossRefPubMed

20.

Peyronnet B et al (2018) Early mobilization is safe after renal trauma: a multicenter study. Eur Urol Suppl 17(2):e199–e202. https://doi.org/10.1016/s1569-9056(18)30983-7 CrossRef

21.

Bukur M, Inaba K, Barmparas G, Paquet C, Best C, Lam L, Plurad D, Demetriades D (2011) Routine follow-up imaging of kidney injuries may not be justified. J Trauma 70(5):1229–1233. https://doi.org/10.1097/TA.0b013e3181e5bb8e CrossRefPubMed

22.

Breen KJ, Sweeney P, Nicholson PJ, Kiely EA, O’Brien MF (2014) Adult blunt renal trauma: routine follow-up imaging is excessive. Urology 84(1):62–67. https://doi.org/10.1016/j.urology.2014.03.013 CrossRefPubMed

Titel: Early discharge in selected patients with low-grade renal trauma
verfasst von: Lucas Freton
Lucie-Marie Scailteux
Marine Hutin
Jonathan Olivier
Quentin Langouet
Marina Ruggiero
Ines Dominique
Clémentine Millet
Sébastien Bergerat
Paul Panayatopoulos
Reem Betari
Xavier Matillon
Ala Chebbi
Thomas Caes
Pierre-Marie Patard
Nicolas Szabla
Nicolas Brichart
Axelle Boehm
Laura Sabourin
Kerem Guleryuz
Charles Dariane
Cédric Lebacle
Jérome Rizk
Alexandre Gryn
François-Xavier Madec
François-Xavier Nouhaud
Xavier Rod
Emmanuel Oger
Gaelle Fiard
Karim Bensalah
Benjamin Pradere
Benoit Peyronnet
for the TRAUMAFUF Collaborative Group
Publikationsdatum: 28.06.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 4/2020
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-019-02855-y

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Klimawandel und Gesundheit: Was Sie in der Hausarztpraxis wissen müssen und tun können

Springer Medizin

Early discharge in selected patients with low-grade renal trauma