Kidney injury and multiple trauma: outcome, course and treatment algorithm. An organ-specific evaluation of 835 patients from the trauma register of the DGU

• Published in: Der Unfallchirurg 2012-08, Vol.115 (8), p.700-707
• Main Authors: Heuer, M, Hussmann, B, Schenck, M, Nast-Kolb, D, Ruchholtz, S, Lefering, R, Paul, A, Taeger, G, Lendemans, S
• Format: Article
• Language: ger
• Subjects: Acute Kidney Injury - mortality; Acute Kidney Injury - therapy; Adult; Algorithms; Comorbidity; Female; Germany - epidemiology; Humans; Male; Multiple Trauma - mortality; Multiple Trauma - therapy; Prevalence; Registries; Renal Dialysis - mortality; Renal Dialysis - utilization; Risk Factors; Survival Analysis; Survival Rate; Treatment Outcome
• ISSN: 1433-044X
• DOI: 10.1007/s00113-010-1909-2

The relevance of renal trauma in severely injured patients within a large collective has not yet been thoroughly reviewed. This study aimed at assessing the prevalence of renal trauma in relation to the outcome and the currently established method of treatment. Altogether data of 35,664 patients of the TraumaRegister of the German Society of Trauma Surgery (DGU) (1996-2007) were interpreted retrospectively. All patients with an injury severity score (ISS) ≥16, direct admission to a trauma center and an age of ≥16 years were included. All patients with abdominal trauma (AIS(Abdomen) ≥2) were compared with patients with abdominal and renal trauma (AIS(Kidney) ≥2). A total of 18,416 patients fulfilled the inclusion criteria of which 6,218 (34.1%) had abdominal injuries. Of these patients with abdominal injury 835 (13.3%) additionally showed a kidney injury (AIS(Abdomen) ≥2, AIS(Kidney) 2-5) and were analyzed according to the classification of the American Association for the Surgery of Trauma (AAST) organ-severity-score. AAST kidney: II°: 45.5%, III°: 31.1%, IV°: 15.6%, V°: 7.8%. Patients with leading kidney injury (grade IV and V) thereby showed a significant increase in mortality (IV: 32.3% and V: 40.0%) and an increase in the need for surgical intervention (IV: 61.5 and V: 81.5%). With an increasing grade of renal injury, however, the ISS is also increased but mortality was not increased over the expected mortality rate (RISC score) due to the additional renal injury. Dialysis rate in the surviving patients showed an increased rate depending on the degree of the kidney injury (II: 5.5%, III: 7.6%, IV: 18.8%, V: 8.3%). The results presented here show the prevalence and the outcome of kidney injury in a large collective within the TraumaRegister of the DGU for the first time. Based on the current literature and the findings a treatment algorithm has been developed.