背景:目的是分析损伤的模式,管理,成像,以及瑞士一级创伤中心肾创伤的后续护理。
方法:我们检查了2008年1月至2018年3月期间到我们机构就诊的138例(>16岁)肾脏器损伤患者。人口统计数据,伤害模式,临床表现,管理,并记录随访情况。
结果:142个受伤肾脏的损伤等级为1级,占25%(n=36),16%的2级(n=23),32%的3级(n=46),24%的四级(n=34),和5级在2%(n=3)。主要的伤害机制是冬季运动(45%)。保守治疗在所有1级肾损伤中都是成功的,91%,86%,35%,2、3、4和5级伤害的33%,分别。在23%的1-3级损伤和57%的4-5级损伤中进行了CT或MRI扫描的早期随访,并发症的临床体征是1-3级损伤的最常见指征和常规随访4-5级损伤的影像学检查,分别。在后续护理中(受伤后1-9个月),影像学显示1-3级肾损伤的39%和4-5级损伤的62%的持续病理。
结论:大多数轻微的肾损伤(1-3级)可以保守治疗。对于出现并发症临床体征的患者,应进行早期随访成像。对于没有临床症状的高度肾损伤,常规重复成像可能是不合理的。后续护理中的重新成像仍然缺乏循证建议。
BACKGROUND: The objective was to analyze patterns of injury, management, imaging, and follow-up care of renal trauma at a Swiss level 1 trauma center.
METHODS: We examined 138 patients (>16 years) with renal organ injuries who presented to our institution between January 2008 and March 2018. Data on demographics, patterns of injury, clinical presentation, management, and follow-up were recorded.
RESULTS: The injury grade of the 142 injured kidneys was grade 1 in 25% (n = 36), grade 2 in 16% (n = 23), grade 3 in 32% (n = 46), grade 4 in 24% (n = 34), and grade 5 in 2% (n = 3). The predominant injury mechanism was winter sports (45%). Conservative management was successful in all grade 1 renal injuries, and 91%, 86%, 35%, and 33% of grade 2, 3, 4, and 5 injuries, respectively. Early follow-up with CT or MRI scan was performed in 23% of grade 1-3 injuries and 57% of grade 4-5 injuries with clinical signs of complications as the most frequent indication for grade 1-3 injuries and routine follow-up imaging for grade 4-5 injuries, respectively. In follow-up care (1-9 months after injury) imaging showed persistent pathologies in 39% of grade 1-3 renal injuries and 62% of grade 4-5 injuries.
CONCLUSIONS: Most minor renal injuries (grade 1-3) can be successfully managed conservatively. Early follow-up imaging is indicated for patients showing clinical signs of complications. Routine repeat imaging may not be justified for high-grade renal injuries without clinical symptoms. Re-imaging in follow-up care still lacks evidence-based recommendations.