Introduction: Expectant management for blunt renal trauma has primarily taken place in ICU settings. Recent reports have questioned this practice, as most patients do not require surgery or angioembolization for low-grade renal injuries. American Association for the Surgery of Trauma renal injury grade (AAST) III injuries are sometimes categorized with AAST IV and V injuries, as “High Grade Renal Trauma.” Unlike AAST IV and V injuries, however, AAST III injuries rarely require surgical or procedural intervention and thus may be candidates for early discharge. We hypothesized that patients with blunt AAST III injuries discharged within 48 hours of admission do not have increased rates of readmission due to renal complications compared to patients observed for more than 48 hours.
Methods: Renal trauma patients from 2005 through 2020 were identified from our institutional trauma registry. Patients with AAST III blunt renal injuries were included. Patients who died within 48 hours of admission were excluded. Univariable analysis was used to identify variables associated with discharge within 48 hours. Reasons for readmission were tabulated and compared between patients who were and were not discharged within 48 hours of admission.
Results: Of the 1751 renal trauma patients, 377 (21.5%) presented with a blunt AAST III renal injury and survived beyond 48 hours from admission. Sixty-five of 377 (17.2%) AAST III injuries were discharged within 48 hours of admission and 312 of 377 (82.8%) were admitted for more than 48 hours. On univariate analysis, arrival condition (responsive vs. unresponsive, p<0.001), hypotension on arrival (p=0.02), Injury Severity Score (ISS, p<0.001) and presence of a splenic injury (p=0.04) were associated with length of stay longer then 48-hours. No patients required a urologic procedure. While 35 patients (9.2%) required a readmission for non-urologic reasons, 3 in the early discharge group and 32 in the group admitted for more than 48 hours, no patients required readmission for renal or urologic reasons.
Conclusions: Intermediate-grade blunt renal traumas have a low risk of complication and intervention, and thus a low rate of readmission, with non-renal injuries often driving a patient’s length of stay and risk for readmission. Select patients with isolated AAST III injuries or AAST III injuries with less severe concomitant injuries may be appropriate for early discharge.
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