High-grade blunt renal trauma (AAST IV–V) at the “Prof. Dr. Manuel Giagni” Trauma Hospital: clinical characteristics and factors associated with in-hospital mortality

Abstract

Introduction: High-grade blunt renal trauma is a clinically relevant injury within abdominal trauma and may be associated with complications and mortality. Objective: To describe the epidemiological and clinical characteristics, management, and factors associated with in-hospital mortality among adults with grade IV–V blunt renal trauma treated at the “Prof. Dr. Manuel Giagni” Trauma Hospital between 2020 and 2024. Materials and Methods: An observational, retrospective, analytical, single-center study based on the review of medical records of patients with grade IV–V blunt renal trauma classified according to the American Association for the Surgery of Trauma (AAST). Demographic variables, injury mechanism, management, complications, transfusion requirements, and mortality were analyzed. Descriptive analysis and multivariable logistic regression were performed to evaluate variables associated with in-hospital mortality. A p-value <0.05 was considered statistically significant. Results: A total of 438 patients were included, with a mean age of 38.6 ± 12.4 years; 70.1% were male. Grade IV injuries accounted for 61.4% and grade V injuries for 38.6%. Conservative management was used in 54.8% of patients. Overall in-hospital mortality was 9.1% and was higher among patients with grade V than grade IV injuries (16.0% vs. 4.8%; p<0.001). In the multivariable model, hemorrhagic shock on admission (aOR 4.26; 95%CI 2.34–7.81; p<0.001), grade V renal injury (aOR 3.87; 95%CI 2.14–6.98; p<0.001), massive transfusion (aOR 2.91; 95%CI 1.72–4.93; p<0.001), age >50 years (aOR 2.43; 95%CI 1.31–4.52; p=0.005), and time to diagnosis >6 hours (aOR 1.98; 95%CI 1.15–3.41; p=0.014) were associated with in-hospital mortality. Conclusion: In this cohort of adults with high-grade blunt renal trauma, mortality was higher among grade V injuries. Hemorrhagic shock on admission, grade V renal injury, massive transfusion, age >50 years, and time to diagnosis >6 hours were independently associated with in-hospital mortality. Because of the retrospective design, these associations should not be interpreted as causal relationships.