Abstract
Introduction
The aim of this study was to assess whether early discharge could be non-inferior to inpatient management in selected patients with low-grade renal trauma (AAST grades 1–3).
Materials and methods
A retrospective national multicenter study was conducted including all patients who presented with renal trauma at 17 hospitals between 2005 and 2015. Exclusion criteria were iatrogenic and AAST grades 4 and 5 trauma, non-conservative initial management, Hb < 10 g/dl or transfusion within the first 24 h, and patients with concomitant injuries. Patients were divided into two groups according to the length of hospital stay: ≤ 48 h (early discharge), and > 48 h (inpatient). The primary outcome was “Intervention” defined as any interventional procedure needed within the first 30 days. A Stabilized Inverse Probability of Treatment Weighting (SIPTW) propensity score based binary response model was used to estimate risk difference.
Results
Out of 1764 patients with renal trauma, 311 were included in the analysis (44 in the early discharge and 267 in the inpatient group). In the early discharge group, only one patient required an intervention within the first 30 days vs. 10 in the inpatient group (3.7% vs. 5.2%; p = 0.99). Adjusted analysis using SIPTW propensity score showed a risk difference of − 2.8% [− 9.3% to + 3.7%] of “interventions” between the two groups meeting the non-inferiority criteria.
Conclusion
In a highly selected cohort, early discharge management of low-grade renal trauma was not associated with an increased risk of early “intervention” compared to inpatient management. Further prospective randomized controlled trials are needed to confirm these findings.
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Abbreviations
- AAST:
-
American Association for the Surgery of Trauma
- CT:
-
Computerized tomography
- IR:
-
Interventional radiology
- NA:
-
Not applicable
- SIPTW:
-
Stabilized Inverse Probability of Treatment Weighting
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Acknowledgements
The TRAUMAFUF Collaborative Group members: Lucas Freton, Lucie-Marie Scailteux, Marine Hutin, Jonathan Olivier, Quentin Langouet, Marina Ruggiero, Ines Dominique, Clémentine Millet, Sébastien Bergerat, Paul Panayatopoulos, Reem Betari, Xavier Matillon, Ala Chebbi, Thomas Caes, Pierre-Marie Patard, Nicolas Szabla, Nicolas Brichart, Axelle Boehm, Laura Sabourin, Kerem Guleryuz, Charles Dariane, Cédric Lebacle, Jérome Rizk, Alexandre Gryn, François-Xavier Madec, François-Xavier Nouhaud, Xavier Rod, Gaelle Fiard, Benjamin Pradere, Benoit Peyronnet.
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LF: data collection, data analyses, manuscript writing. L-MS: data analyses. MH: data collection. JO: data collection. QL: data collection. MR: data collection. ID: data collection. CM: data collection. SB: data collection. PP: project development. RB: data collection. XM: project development. AC: data collection. TC: data collection. P-MP: data collection. NS: data collection. NB: data collection. AB: data collection. LS: data collection. KG: data collection. CD: project development. CL: project development, manuscript editing. JR: data collection. AG: data collection. F-XM: data collection. F-XN: data collection. XR: data collection. EO: data analyses. GF: project development, manuscript editing. KB: manuscript editing. BP: project development, data management. BP: project development, data management, data analyses, manuscript editing.
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Freton, L., Scailteux, LM., Hutin, M. et al. Early discharge in selected patients with low-grade renal trauma. World J Urol 38, 1009–1015 (2020). https://doi.org/10.1007/s00345-019-02855-y
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DOI: https://doi.org/10.1007/s00345-019-02855-y