Selective nonoperative management of blunt grade 5 renal injury

Purpose: We determined the feasibility of a nonoperative approach to blunt grade 5 renal injury. Materials and Methods: We retrospectively reviewed the records of all patie nts with grade 5 renal injury who presented to our level 1 trauma center fr om 1993 to 1998. Those treated nonoperatively and surgically were assigned to groups 1 and 2, respectively. Each group was compared with respect to th e initial emergency department evaluation, computerized tomography findings , associated injuries, duration of hospital stay and intensive care unit st ay, transfusion requirements, complications and followup imaging. Results: Of 218 renal injuries evaluated 13 were grade 5. In group 1, 6 pat ients were treated nonoperatively and in group 2, 7 underwent exploration. Each group had similar average hospitalization (12.0 and 12.8 days, respect ively). Patients in group 1 had fewer intensive care unit days (4.3 versus 9.0), significantly lower transfusion requirements (2.7 versus 25.2 units, p = 0.0124) and fewer complications during the hospital course. Followup co mputerized tomography of nonoperatively managed cases revealed functioning renal parenchyma with resolution of retroperitoneal hematoma. Conclusions: Conservative management of blunt grade 5 renal injury is feasi ble in patients who are hemodynamically stable at presentation.