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Successful Non-operative Management Of The Most Severe Blunt Renal Injuries: A Multicenter Study Of The Research Consortium Of New England Centers For Trauma (ReCONECT)
*Gwendolyn M van der Wilden1, George C Velmahos1, *D'Andrea K Joseph2, Lenworth Jacobs2, *M. George DeBusk3, Charles A. Adams3, Ronald Gross4, *Barbara Burkott4, Suresh Agarwal5, *Adrian A. Maung6, *Dirk C Johnson6, Jonathan Gates7, Edward Kelly7, *Yvonne Michaud7, William E Charash8, Robert J Winchell9, *Steven E Desjardins9, Michael S. Rosenblatt10, *Sanjay Gupta11, *Miguel Gaeta12, *Yuchiao Chang1, *Marc A de Moya1
1Massachusetts General Hospital, Boston, MA;2Hartford Hospital, Hartford, CT;3Rhode Island Hospital, Providence, RI;4Baystate Medical Center, Springfield, MA;5Boston Medical Center, Boston, MA;6Yale New Haven Hospital, New Haven, CT;7Brigham and Womens Hospital, Boston, MA;8University of Vermont, College of Medicine, Burlington, VT;9Maine Medical Center, Portland, ME;10Lahey Clinic, Burlington, MA;11Southern New Hampshire Medical Center, Nashua, NH;12Elliot Hospital, Manchester, NH

Objective: To determine the rate, causes, predictors, and consequences of failure of non-operative management (NOM) in grade IV and V blunt renal injuries (BRI).
Design: Retrospective case series.
Setting: Twelve trauma centers in New England Patients: 209 adult patients with a grade IV or V BRI who where admitted between January 1, 2000, and December 31, 2011. Main Outcome Measures: Failure of NOM, defined as the need for delayed operation.
Results: 52 patients (25%) were operated on immediately and 157 (75%) were managed non-operatively (with the assistance of angiographic embolization in 26 patients). NOM failed in 13 patients (8%) and was related to kidney injury in 11 (7%), who underwent a (partial) nephrectomy. None of these 11 patients suffered complications because of delay in BRI management. The time from admission to failure was 0.9+0.9 days (range: 1 to 4), and the cause was hemodynamic instability in all cases. Multivariate analysis identified 2 independent predictors of NOM failure: Age > 55 years and road traffic crash as mechanism of injury. When both risk factors were present, NOM failure occurred in 30% of patients; when both were absent, there were no NOM failures. Among patients successfully managed by NOM, 40 (28%) developed renal-related complications, including hematuria (22), urinoma (12), urinary tract infection (8), renal failure (7), and abscess (1). These were all managed successfully. The renal salvage rate was 79% for the entire population, and 94% among patients selected for NOM.
Conclusions: Hemodynamically stable patients with grade IV and V BRI were safely managed by NOM. Only 8% failed NOM and three fourths of the entire population retained their kidneys.

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Abstract Submission Deadline:
May 5, 2014

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August 13, 2014

Early Bird Registration Deadline:
August 11, 2014
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