Journal article
A nomogram predicting the need for bleeding interventions after high-grade renal trauma: Results from the American Association for the Surgery of Trauma Multi-institutional Genito-Urinary Trauma Study (MiGUTS)
The journal of trauma and acute care surgery, Vol.86(5), pp.774-782
05/2019
DOI: 10.1097/TA.0000000000002222
PMID: 30741884
Abstract
The management of high-grade renal trauma (HGRT) and the indications for intervention are not well defined. The American Association for the Surgery of Trauma (AAST) renal grading does not incorporate some important clinical and radiologic variables associated with increased risk of interventions. We aimed to use data from a multi-institutional contemporary cohort to develop a nomogram predicting risk of interventions for bleeding after HGRT.
From 2014 to 2017, data on adult HGRT (AAST grades III-V) were collected from 14 level 1 trauma centers. Patients with both clinical and radiologic data were included. Data were gathered on demographics, injury characteristics, management, and outcomes. Clinical and radiologic parameters, obtained after trauma evaluation, were used to predict renal bleeding interventions. We developed a prediction model by applying backward model selection to a logistic regression model and built a nomogram using the selected model.
A total of 326 patients met the inclusion criteria. Mechanism of injury was blunt in 81%. Median age and injury severity score were 28 years and 22, respectively. Injuries were reported as AAST grades III (60%), IV (33%), and V (7%). Overall, 47 (14%) underwent interventions for bleeding control including 19 renal angioembolizations, 16 nephrectomies, and 12 other procedures. Of the variables included in the nomogram, a hematoma size of 12 cm contributed the most points, followed by penetrating trauma mechanism, vascular contrast extravasation, pararenal hematoma extension, concomitant injuries, and shock. The area under the receiver operating characteristic curve was 0.83 (95% confidence interval, 0.81-0.85).
We developed a nomogram that integrates multiple clinical and radiologic factors readily available upon assessment of patients with HGRT and can provide predicted probability for bleeding interventions. This nomogram may help in guiding appropriate management of HGRT and decreasing unnecessary interventions.
Prognostic and epidemiological study, level III.
Details
- Title: Subtitle
- A nomogram predicting the need for bleeding interventions after high-grade renal trauma: Results from the American Association for the Surgery of Trauma Multi-institutional Genito-Urinary Trauma Study (MiGUTS)
- Creators
- Sorena Keihani - From the Division of Urology, Department of Surgery (S.K., R.A.M., J.M.H., J.B.M.), Department of Radiology (D.M.R., B.E.P.), Division of Epidemiology, Department of Internal Medicine (C.Z., A.P.P.), and Department of Surgery (R.N.), University of Utah, Salt Lake City, Utah; Division of Acute Care Surgery (X.L-O., K.M.), Loma Linda University Medical Center, Loma Linda, California; Division of Trauma and Surgical Critical Care (B.J.M., S.M.), Intermountain Medical Center, Murray, Utah; Department of Urology (J.P.), and Department of Surgery (C.M.D.), University of Wisconsin, Milwaukee, Wisconsin; Department of Urology (I.S., S.P.E.), Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota; Department of Surgery (E.S.D.), and Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery (S.Z.), University of California Davis Medical Center, Sacramento, California; Department of Urology (B.G.S., B.A.E.), University of Iowa, Iowa City, Iowa; Department of Urology (N.B., B.N.B.), University of California-San Francisco, San Francisco, California; Division of Trauma and Surgical Critical Care (B.P.S.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Trauma, Department of Surgery (B.U.O., R.A.), Brigham and Women's Hospital, Boston, Massachusetts; Department of Urology (B.M., R.A.S.), Detroit Medical Center, Detroit, Michigan; Medical City Plano (M.M.C.), Plano; Department of Surgery (J.F.K.), East Texas Medical Center, Tyler, Texas; Department of Urology (T.H., F.N.B.), Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; Department of Radiology and Imaging Sciences (M.E.H.), Emory University Hospital, Atlanta, GeorgiaDouglas M RogersBryn E PutbreseRachel A MosesChong ZhangAngela P PressonJames M HotalingRaminder NirulaXian Luo-OwenKaushik MukherjeeBradley J MorrisSarah MajercikJoshua PiotrowskiChristopher M DodgionIan SchwartzSean P ElliottErik S DeSoucyScott ZakaluznyBrenton G SherwoodBradley A Erickson - University of Iowa, UrologyNima BaradaranBenjamin N BreyerBrian P Smith - University of Iowa, Preventive and Community DentistryBarbara U OkaforReza AskariBrandi Miller - Detroit Medical CenterRichard A SantucciMatthew M CarrickJurek F KocikTimothy HewittFrank N BurksMarta E HeilbrunJeremy B Myersin conjunction with the Trauma and Urologic Reconstruction Network of Surgeons
- Resource Type
- Journal article
- Publication Details
- The journal of trauma and acute care surgery, Vol.86(5), pp.774-782
- DOI
- 10.1097/TA.0000000000002222
- PMID
- 30741884
- NLM abbreviation
- J Trauma Acute Care Surg
- ISSN
- 2163-0755
- eISSN
- 2163-0763
- Grant note
- T35 HL007485 / NHLBI NIH HHS UL1 TR001067 / NCATS NIH HHS UL1 TR000105 / NCATS NIH HHS UL1 RR025764 / NCRR NIH HHS
- Language
- English
- Date published
- 05/2019
- Academic Unit
- Urology
- Record Identifier
- 9984051722702771
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