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 Luchey1 1Department of Urology, West Virginia University, Morgantown, WV, USA; 2School of Medicine, West Virginia University, Morgantown, WV, USA; 3Department of Surgery, West Virginia University, Morgantown,...
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Dove Medical Press
2022-03-01
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| Series: | Research and Reports in Urology |
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| Online Access: | https://www.dovepress.com/implementation-of-a-standardized-renal-trauma-protocol-at-a-level-1-tr-peer-reviewed-fulltext-article-RRU |
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| author | Werner Z Haffar A Bacharach E Knight-Davis J Hajiran A Luchey A |
| author_facet | Werner Z Haffar A Bacharach E Knight-Davis J Hajiran A Luchey A |
| author_sort | Werner Z |
| collection | DOAJ |
| description | Zachary Werner,1 Ahmad Haffar,2 Emma Bacharach,1 Jennifer Knight-Davis,3 Ali Hajiran,1 Adam Luchey1 1Department of Urology, West Virginia University, Morgantown, WV, USA; 2School of Medicine, West Virginia University, Morgantown, WV, USA; 3Department of Surgery, West Virginia University, Morgantown, WV, USACorrespondence: Ahmad Haffar, School of Medicine, West Virginia University, Suite 6300 Health Sciences Center Morgantown, Morgantown, WV, 26505, USA, Tel +304 993-2237, Fax +304 293-2807, Email aihaffar@mix.wvu.eduObjective: 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: renal, trauma, review, protocol, thromboembolic |
| first_indexed | 2024-12-12T21:25:46Z |
| format | Article |
| id | doaj.art-efc4bccf8dcb4e2696a558e05837fbcc |
| institution | Directory Open Access Journal |
| issn | 2253-2447 |
| language | English |
| last_indexed | 2024-12-12T21:25:46Z |
| publishDate | 2022-03-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Research and Reports in Urology |
| spelling | doaj.art-efc4bccf8dcb4e2696a558e05837fbcc2022-12-22T00:11:28ZengDove Medical PressResearch and Reports in Urology2253-24472022-03-01Volume 14798573755Implementation of a Standardized Renal Trauma Protocol at a Level 1 Trauma Center: 7-Year Protocol and 10-Year Institutional ReviewWerner ZHaffar ABacharach EKnight-Davis JHajiran ALuchey AZachary Werner,1 Ahmad Haffar,2 Emma Bacharach,1 Jennifer Knight-Davis,3 Ali Hajiran,1 Adam Luchey1 1Department of Urology, West Virginia University, Morgantown, WV, USA; 2School of Medicine, West Virginia University, Morgantown, WV, USA; 3Department of Surgery, West Virginia University, Morgantown, WV, USACorrespondence: Ahmad Haffar, School of Medicine, West Virginia University, Suite 6300 Health Sciences Center Morgantown, Morgantown, WV, 26505, USA, Tel +304 993-2237, Fax +304 293-2807, Email aihaffar@mix.wvu.eduObjective: 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: renal, trauma, review, protocol, thromboembolichttps://www.dovepress.com/implementation-of-a-standardized-renal-trauma-protocol-at-a-level-1-tr-peer-reviewed-fulltext-article-RRUrenaltraumareviewprotocolthromboembolic |
| spellingShingle | Werner Z Haffar A Bacharach E Knight-Davis J Hajiran A Luchey A Implementation of a Standardized Renal Trauma Protocol at a Level 1 Trauma Center: 7-Year Protocol and 10-Year Institutional Review Research and Reports in Urology renal trauma review protocol thromboembolic |
| title | Implementation of a Standardized Renal Trauma Protocol at a Level 1 Trauma Center: 7-Year Protocol and 10-Year Institutional Review |
| title_full | Implementation of a Standardized Renal Trauma Protocol at a Level 1 Trauma Center: 7-Year Protocol and 10-Year Institutional Review |
| title_fullStr | Implementation of a Standardized Renal Trauma Protocol at a Level 1 Trauma Center: 7-Year Protocol and 10-Year Institutional Review |
| title_full_unstemmed | Implementation of a Standardized Renal Trauma Protocol at a Level 1 Trauma Center: 7-Year Protocol and 10-Year Institutional Review |
| title_short | Implementation of a Standardized Renal Trauma Protocol at a Level 1 Trauma Center: 7-Year Protocol and 10-Year Institutional Review |
| title_sort | implementation of a standardized renal trauma protocol at a level 1 trauma center 7 year protocol and 10 year institutional review |
| topic | renal trauma review protocol thromboembolic |
| url | https://www.dovepress.com/implementation-of-a-standardized-renal-trauma-protocol-at-a-level-1-tr-peer-reviewed-fulltext-article-RRU |
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