Management of Renal Injuries From Military Combat Trauma: The Department of Defense Trauma Registry Experience

Objective To evaluate the severity and management of renal injuries during the Global War on Terror (GWOT) using the Department of Defense Trauma Registry (DODTR). Methods Data was analyzed from the DODTR from 2007-2023. Patients with renal injuries were identified using ICD-9 codes. Patients were evaluated on whether they underwent nephrectomy or observation as management. Descriptive and inferential statistics were used to characterize those undergoing observation vs nephrectomy. Results There were 707 patients identified with renal injuries that met inclusion. Casualties had a median age of 24 years. US Military accounted for 177 (25%) patients while 291 (41%) were humanitarian. 203 (29%) patients underwent nephrectomy and 504 (71%) were managed conservatively with observation. The nephrectomy group had a higher proportion of firearm mechanism of injury than the observation group (61% vs 29%). The abbreviated injury scale (AIS) category scores for the abdomen and pelvis were higher in the nephrectomy group. Patients undergoing nephrectomy consumed more crystalloid (5.6 L [interquartile range/IQR 3.2, 9.5] vs 3.5 L [IQR 1.1, 6.2]), red blood cells (8 units [IQR 3, 16] vs 2 units [IQR 0, 8]), and plasma (7 units [IQR 2,15] vs 2 units [IQR 0, 8]). Patients undergoing nephrectomy were more likely to have high-grade renal injuries (56% vs 8%, P < .001). Conclusion The nephrectomy rate from combat-related renal injuries was high during the GWOT. More research is needed on combat-specific renal injuries to further improve guidelines, treatment strategies, and predeployment training.