ObjectiveTo systematically investigate and analyse the aggregated data from recent studies to provide a quantitative synthesis for a conservative approach to the management of high‐grade kidney trauma, as accumulating evidence supports the favourable outcomes of a conservative approach.MethodsA comprehensive search was performed using databases, including PubMed, EBSCO, ProQuest, Google Scholar, and Cochrane Library, to identify studies relevant to high‐grade renal trauma in both adult and paediatric populations. The compare review focused on comparing conservative management interventions, such as observation, rest, resuscitation, transfusion, symptomatic management, and angioembolisation, with operative management interventions. Search strategies incorporated specific medical subject headings and keywords related to conservative management, kidney trauma, mortality, and renal preservation. Random and fixed‐effect meta‐analyses were conducted to estimate the rates of nephrectomy and mortality, respectively.ResultsA total of 36 and 29 studies were included for qualitative and quantitative synthesis, respectively. The aggregated data showed a cumulative risk difference of 0.52 (95% confidence interval [CI] 0.38–0.66, P < 0.001), indicating a higher likelihood of nephrectomy in cases where operative management was used instead of conservative management. In terms of mortality, conservative management demonstrated a lower risk difference of 0.09 (95% CI 0.05–0.13, P < 0.001).ConclusionThe results indicate that opting for conservative management in cases of high‐grade renal trauma, particularly for haemodynamically stable patients, presents a lower risk of mortality and reduced probability of requiring nephrectomy when compared to operative management. These findings provide strong evidence in favour of considering conservative management as a viable and effective treatment option for high‐grade renal trauma.

中文翻译：

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高度肾损伤的保守治疗：系统评价和荟萃分析

目的系统地调查和分析最近研究的汇总数据，为治疗重度肾损伤的保守方法提供定量综合，因为越来越多的证据支持保守方法的有利结果。方法使用数据库进行全面搜索，包括 PubMed、EBSCO、ProQuest、Google Scholar 和 Cochrane Library，以确定与成人和儿童群体中的重度肾损伤相关的研究。比较综述的重点是比较保守治疗干预措施，如观察、休息、复苏、输血、对症治疗和血管栓塞术，与手术治疗干预措施。搜索策略包含与保守治疗、肾损伤、死亡率和肾脏保存相关的特定医学主题标题和关键词。进行随机和固定效应荟萃分析，分别估计肾切除术的发生率和死亡率。结果 分别纳入 36 项和 29 项研究进行定性和定量综合。汇总数据显示累积风险差异为 0.52（95% 置信区间 [CI] 0.38–0.66，磷< 0.001），表明在使用手术治疗而不是保守治疗的情况下进行肾切除术的可能性更高。就死亡率而言，保守治疗显示风险差异较低，为 0.09（95% CI 0.05–0.13，磷< 0.001）。结论结果表明，与手术治疗相比，在严重肾损伤的情况下选择保守治疗，特别是对于血流动力学稳定的患者，死亡风险较低，并且需要肾切除术的可能性也较低。这些发现提供了强有力的证据，支持考虑保守治疗作为重度肾损伤的可行且有效的治疗选择。