The value of a history from conscious patients, witnesses, and EMS personnel cannot be overstated. In blunt trauma, a blow to the flank or rapid deceleration mechanism (eg, high-speed motor vehicle crash or fall from significant height) is suggestive of trauma to the upper GU tract. Rapid deceleration is associated with vascular injury to the kidney, such as avulsion of the vascular pedicle and renal artery thrombosis.24 Some salient historical features in renal and GU trauma are common to all abdominal trauma: in motor vehicle and motorcycle crashes as well as pedestrians struck, the speed of the vehicle(s) involved and whether the patient was restrained, ejected, or airborne are important considerations. The presence of seatbelt use and airbag deployment is correlated to a decreased rate of nephrectomy in renal trauma patients.47
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