Between 3 to 5 percent of trauma victims present with renal injuries, making the kidney the most frequently injured genitourinary organ.1,2 Although a substantial portion of renal injuries are the result of blunt force, penetrating trauma accounts for 29 percent of all kidney injuries,2 and stab wounds have been shown to comprise approximately 17 percent of all penetrating renal trauma injuries.2,3 Despite its relative scarcity, understanding how to diagnose and treat this potentially deadly condition remains of utmost importance.
Diagnosis and intervention
The diagnosis of renal stab wounds should use a combination of clinical acumen and cross-sectional imaging. Guidelines suggest that intravenous contrast-enhanced computerized tomography should be used in stable patients who have signs of renal trauma or who the clinician suspects may have experienced renal trauma.1 It is important that imaging occurs in both immediate and delayed phases to adequately assess the blood supply and the collecting system.1 Hematuria and hemodynamic instability are insufficient markers of renal injuries, and clinicians should pursue more aggressive imaging if renal injury is suspected.1,4
If a clinician diagnoses a renal stab wound in a stable patient, every effort should be made to manage it conservatively. Intervention is warranted in unstable patients or patients who do not respond appropriately to resuscitative efforts.1 Definitive intervention will vary by specific situation and grade of renal laceration, ranging from angioembolization to surgical repair. Regardless of the management strategy, it is imperative to first control the bleeding and then determine the best means of repairing the kidney and draining the perirenal space.1
Findings
To examine the occurrence of patients with knife wounds to the kidneys in the National Trauma Data Bank® (NTDB®) research admission year 2017, medical records were searched using the International Classification of Diseases, 10th Revision Clinical Modification codes. Specifically searched were records that contained E code X99.1 (assault by knife) and a diagnosis code of S37.0 (injury of the kidney). A total of 237 records were found, 216 of which contained a discharge status, including 197 patients discharged to home, seven to acute care/rehab, five to law enforcement, and one to skilled nursing facilities; six died (see Figure 1). Of these patients, 84.8 percent were men, on average 33.7 years of age, had an average hospital length of stay of 6.6 days, an intensive care unit length of stay of 4.1 days, an average injury severity score of 15, and were on the ventilator for an average of four days. Of those patients tested for alcohol, 42 percent (71 out of 168) tested positive.
Figure 1. Hospital Discharge Status
