Renal injuries in conflict zones: a 6-year study of traumatic cases in Afghanistan.
Combat trauma
Penetrating trauma
Traumatic renal injuries
Treatment strategy
Journal
Conflict and health
ISSN: 1752-1505
Titre abrégé: Confl Health
Pays: England
ID NLM: 101286573
Informations de publication
Date de publication:
06 Jan 2024
06 Jan 2024
Historique:
received:
26
07
2023
accepted:
28
12
2023
medline:
6
1
2024
pubmed:
6
1
2024
entrez:
5
1
2024
Statut:
epublish
Résumé
During hostilities, gunshot wounds are the most common cause of penetrating injuries. In 8-10% of abdominal injuries kidneys are involved. The treatment method include surgical or conservative treatment (fluids + blood components). Of 1266 combat trauma cases treated during 6 to 14 rotation of the Polish Military Contingent in Afghanistan, we extracted a subgroup of 44 kidney injuries. Corelation of trauma mechanism, PATI score, treatment methods, and outcomes was evaluated. Out of the 41 renal injuries, 20 considered left, 18 right, and 3 both kidneys. There were no statistical significancy in injury lateralization (p = 0.669), and no differences regarding side of a trauma and quantity of blood component used for the treatment (p = 0.246). Nephrectomy was performed on 17 patients (13 left vs. 4 right). A significant correlation between PATI score and the need for a nephrectomy (p = 0.027) was confirmed. Penetrating trauma recquired higher number of blood components comparing to blunt trauma (p < 0.001). The renal salvage rate was in study group was 61.36%. The overall survival (OS) rate was 90.25% - 4 patients died due to trauma. The damage side does not result in a statistically significant increase in the need for blood transfusions or differences in the PATI score. The mechanism of trauma does, however, affect the number of blood components required for treatment, particularly in cases of penetrating trauma. With the introduction of proper treatment, the overall survival rate exceeds 90%, even when opting for conservative treatment.
Identifiants
pubmed: 38183150
doi: 10.1186/s13031-023-00566-1
pii: 10.1186/s13031-023-00566-1
doi:
Types de publication
Journal Article
Langues
eng
Pagination
6Informations de copyright
© 2024. The Author(s).
Références
Petrone P, Perez-Calvo J, Brathwaite CEM, Islam S, Joseph DK. Traumatic kidney injuries: a systematic review and meta-analysis. Int J Surg. 2020;74:13–21. https://doi.org/10.1016/j.ijsu.2019.12.013 .
doi: 10.1016/j.ijsu.2019.12.013
pubmed: 31870753
Singh S, Sookraj K, Kidney Trauma. [Updated 2022 Jul 18]. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
Erlich T, Kitrey ND. Renal trauma: the current best practice. Ther Adv Urol. 2018;10(10):295–303. https://doi.org/10.1177/1756287218785828 . Published 2018 Jul 10.
doi: 10.1177/1756287218785828
pubmed: 30186367
pmcid: 6120183
Freton L, Scailteux LM, Hutin M, et al. Early discharge in selected patients with low-grade renal trauma. World J Urol. 2020;38(4):1009–15. https://doi.org/10.1007/s00345-019-02855-y .
doi: 10.1007/s00345-019-02855-y
pubmed: 31254097
Bjurlin MA, Goble SM, Fantus RJ, Hollowell CM. Outcomes in geriatric genitourinary trauma. J Am Coll Surg. 2011;213(3):415–21. https://doi.org/10.1016/j.jamcollsurg.2011.06.001 .
doi: 10.1016/j.jamcollsurg.2011.06.001
pubmed: 21723152
Lotfollahzadeh S, Burns B. Penetrating abdominal trauma. StatPearls. Treasure Island (FL). StatPearls Publishing; 2023:15.
Pinto A, Russo A, Reginelli A, et al. Gunshot wounds: ballistics and imaging findings. Semin Ultrasound CT MR. 2019;40(1):25–35. https://doi.org/10.1053/j.sult.2018.10.018 .
doi: 10.1053/j.sult.2018.10.018
pubmed: 30686364
Shrestha R, Kanchan T, Krishan K. StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Gunshot Wounds Forensic Pathology. [Updated 2022 May 15].
Sablone S, Lagona V, Introna F. An unusual case of fatal Thoracoabdominal Gunshot Wound without Diaphragm Injury. Diagnostics. 2022;12(4):899. https://doi.org/10.3390/diagnostics12040899 .
doi: 10.3390/diagnostics12040899
pubmed: 35453947
pmcid: 9024727
Gumeniuk K, Lurin IA, Tsema I, Malynovska L, Gorobeiko M, Dinets A. Gunshot Injury to the colon by expanding bullets in combat patients wounded in hybrid period of the russian-ukrainian War during 2014–2020. BMC Surg. 2023;23(1):23. https://doi.org/10.1186/s12893-023-01919-6 .
doi: 10.1186/s12893-023-01919-6
pubmed: 36707838
pmcid: 9883919
Naeem M, Hoegger MJ, Petraglia FW 3rd, et al. CT of Penetrating Abdominopelvic Trauma Radiographics. 2021;41(4):1064–81. https://doi.org/10.1148/rg.2021200181 .
doi: 10.1148/rg.2021200181
pubmed: 34019436
Dieter RA Jr., Kuzycz GB, Dieter RS, Dieter RA III. Traumatic urinary bladder and renal artery disruption with kidney Salvage—A Case Report. Uro. 2023;3(1):20–6. https://doi.org/10.3390/uro3010004 .
doi: 10.3390/uro3010004
Maqungo S, Swan A, Naude P, Held M, Kruger N, McCollum G, Laubscher M. The management of low velocity transarticular Gunshot injuries: a pilot study. SA Orthop J. 2018;17(2):25–7. https://doi.org/10.17159/2309-8309/2018/v17n2a4 .
doi: 10.17159/2309-8309/2018/v17n2a4
Raza SJ, Xu P, Barnes J, et al. Outcomes of renal salvage for penetrating renal trauma: a single institution experience. Can J Urol. 2018;25(3):9323–7.
pubmed: 29900820
Gillams K, Jones P, Hawary A. Conservative management of a patient with a renal Gunshot Injury. Br J Hosp Med (Lond). 2021;82(7):1–2. https://doi.org/10.12968/hmed.2020.0743 .
doi: 10.12968/hmed.2020.0743
pubmed: 34338023
McAninch JW, Carroll PR, Armenakas NA, Lee P. Renal Gunshot wounds: methods of salvage and reconstruction. J Trauma. 1993;35(2):279–84.
doi: 10.1097/00005373-199308000-00018
pubmed: 8355309
Hope WW, Smith ST, Medieros B, Hughes KM, Kotwall CA, Clancy TV. Non-operative management in penetrating abdominal trauma: is it feasible at a level II trauma center? J Emerg Med. 2012;43(1):190–5. https://doi.org/10.1016/j.jemermed.2011.06.060 .
doi: 10.1016/j.jemermed.2011.06.060
pubmed: 22051843
Forbes J, Burns B. Abdominal Gunshot wounds. [Updated 2023 Feb 15]. StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
Durso AM, Paes FM, Caban K, et al. Evaluation of penetrating abdominal and pelvic trauma. Eur J Radiol. 2020;130:109187. https://doi.org/10.1016/j.ejrad.2020.109187 .
doi: 10.1016/j.ejrad.2020.109187
pubmed: 32745896
McClung CD, Hotaling JM, Wang J, Wessells H, Voelzke BB. Contemporary trends in the immediate surgical management of renal trauma using a national database. J Trauma Acute Care Surg. 2013;75(4):602–6. https://doi.org/10.1097/TA.0b013e3182a53ac2 .
doi: 10.1097/TA.0b013e3182a53ac2
pubmed: 24064872
Cardi M, Ibrahim K, Alizai SW, et al. Injury patterns and causes of death in 953 patients with penetrating abdominal War wounds in a civilian Independent non-governmental organization hospital in Lashkargah, Afghanistan. World J Emerg Surg. 2019;14:51. https://doi.org/10.1186/s13017-019-0272-z .
doi: 10.1186/s13017-019-0272-z
pubmed: 31832085
pmcid: 6868865
Rozen N, Dudkiewicz I. Wound ballistics and tissue damage. In: Lerner A, Soudry M, editors. Armed Conflict injuries to the extremities. Berlin, Heidelberg: Springer; 2011. https://doi.org/10.1007/978-3-642-16155-1_2 .
doi: 10.1007/978-3-642-16155-1_2
Baum GR, Baum JT, Hayward D, MacKay BJ. Gunshot wounds: ballistics, Pathology, and treatment recommendations, with a focus on retained bullets. Orthop Res Rev. 2022;14:293–317. https://doi.org/10.2147/ORR.S378278 .
doi: 10.2147/ORR.S378278
pubmed: 36090309
pmcid: 9462949
Kitrey ND, Djakovic N, Gonsalves M et al. EAU guidelines on Urological Trauma. EAU 2016:1–42.
Stefanopoulos PK, Pinialidis DE, Hadjigeorgiou GF, Filippakis KN. Wound ballistics 101: the mechanisms of soft tissue wounding by bullets. Eur J Trauma Emerg Surg. 2017;43(5):579–86. https://doi.org/10.1007/s00068-015-0581-1 .
doi: 10.1007/s00068-015-0581-1
pubmed: 26470704
Bloom BA, Gibbons RC. Focused Assessment with Sonography for Trauma. [Updated 2023 Feb 5]. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.
Stefanopoulos PK, Hadjigeorgiou GF, Filippakis K, Gyftokostas D. Gunshot wounds: a review of ballistics related to penetrating trauma. J Acute Disease. 2014;3(3):178–85. https://doi.org/10.1016/S2221-6189(14)60041-X .
doi: 10.1016/S2221-6189(14)60041-X
Taş H, Şenocak R, Kaymak Ş, et al. Experiences of Conflict Zone-Related Ballistic Renal Injury. Indian J Surg. 2016;78:299–303. https://doi.org/10.1007/s12262-015-1380-y .
doi: 10.1007/s12262-015-1380-y
pubmed: 27574348
Voelzke BB, McAninch JW. Renal Gunshot wounds: clinical management and outcome. J Trauma. 2009;66(3):593–601. https://doi.org/10.1097/TA.0b013e318196d0dd .
doi: 10.1097/TA.0b013e318196d0dd
pubmed: 19276726
Lee H, Kong V, Cheung C, et al. Trends in the management of abdominal Gunshot wounds over the last decade: a South African experience. World J Surg. 2022;46(5):998–1005. https://doi.org/10.1007/s00268-022-06469-1 .
doi: 10.1007/s00268-022-06469-1
pubmed: 35147739
Resch TR, Kufera JA, Chiu W, Scalea TM. Penetrating renal trauma: Nonoperative Management is safe in selected patients. Am Surg. 2019;85(3):266–72.
doi: 10.1177/000313481908500330
pubmed: 30947772
Hadjipavlou M, Grouse E, Gray R, et al. Managing penetrating renal trauma: experience from two major trauma centres in the UK. BJU Int. 2018;121(6):928–34. https://doi.org/10.1111/bju.14165 .
doi: 10.1111/bju.14165
pubmed: 29438587
Schellenberg M, Benjamin E, Piccinini A, Inaba K, Demetriades D. Selective nonoperative management of renal Gunshot wounds. J Trauma Acute Care Surg. 2019;87(6):1301–7. https://doi.org/10.1097/TA.0000000000002475 .
doi: 10.1097/TA.0000000000002475
pubmed: 31425472
Goldman C, Shaw N, du Plessis D, Myers JB, van der Merwe A, Venkatesan K. Gunshot wounds to the penis and scrotum: a narrative review of management in civilian and military settings. Transl Androl Urol. 2021;10(6):2596–608. https://doi.org/10.21037/tau-20-1175 .
doi: 10.21037/tau-20-1175
pubmed: 34295746
pmcid: 8261456
Paquette EL. Genitourinary trauma at a combat support hospital during Operation Iraqi Freedom: the impact of body armor. J Urol. 2007;177(6):2196–9. https://doi.org/10.1016/j.juro.2007.01.132 .
doi: 10.1016/j.juro.2007.01.132
pubmed: 17509316
Yang CW, Li S, Dong Y, Paliwal N, Wang Y. Epidemiology and the impact of Acute kidney Injury on outcomes in patients with Rhabdomyolysis. J Clin Med. 2021;10(9):1950. https://doi.org/10.3390/jcm10091950 . Published 2021 May 1.
doi: 10.3390/jcm10091950
pubmed: 34062839
pmcid: 8125267
Chávez-Iñiguez JS, Ibarra-Estrada MA, Granado RCD, et al. Acute kidney injury in renal trauma patients. Clin Nephrol. 2021;95(3):143–50. https://doi.org/10.5414/CN110349 .
doi: 10.5414/CN110349
pubmed: 33211003
Sessa F, Cocimano G, Esposito M, Zuccarello P, Scoto E, Mazzeo P, Salerno M. Systematic review of penetrating Cardiac Injury by a Firearm: forensic implications. Healthcare. 2023;11(2):265. https://doi.org/10.3390/healthcare11020265 .
doi: 10.3390/healthcare11020265
pubmed: 36673633
pmcid: 9859264
World MJ. Renal function after trauma. J R Army Med Corps. 2013;159(2):94–7. https://doi.org/10.1136/jramc-2013-000042 .
doi: 10.1136/jramc-2013-000042
pubmed: 23720590
Golino G, Greco M, Rigobello A, Danzi V, De Cal M, Malchiorna N, Zannella M, Navalesi P, Costa-Pinto R, Ronco C, et al. Incidence of Acute kidney Injury in Polytrauma patients and Predictive Performance of TIMP2 × IGFBP7 biomarkers for early identification of Acute kidney Injury. Diagnostics. 2022;12(10):2481. https://doi.org/10.3390/diagnostics12102481 .
doi: 10.3390/diagnostics12102481
pubmed: 36292170
pmcid: 9601128
Jana S, Mitra P, Roy S. Proficient novel biomarkers Guide Early detection of Acute kidney Injury: a review. Diseases. 2023;11(1):8. https://doi.org/10.3390/diseases11010008 .
doi: 10.3390/diseases11010008