Journal article
Shattered Kidney After Renal Trauma: Should it be Classified as an American Association for the Surgery of Trauma (AAST) Grade V Injury?
Urology (Ridgewood, N.J.), Vol.179, pp.181-187
09/2023
DOI: 10.1016/j.urology.2023.06.015
PMID: 37356461
Abstract
To study the prevalence and management of shattered kidney and to evaluate if the new description of “loss of identifiable renal anatomy” in the 2018 American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) would improve the ability to predict bleeding control interventions.
We used high-grade renal trauma (HGRT) data from 21 Level-1 trauma centers from 2013-2018. Initial CT scans were reviewed to identify shattered kidneys, defined as a kidney having ≥3 parenchymal fragments displaced by blood or fluid on cross-sectional imaging. We further categorized patients with shattered kidney in two models based on loss of identifiable renal parenchymal anatomy and presence or absence of vascular contrast extravasation (VCE). Bleeding interventions were compared between the groups.
From 861 HGRT patients, 41 (4.8%) had shattered kidney injury. 25 (61%) underwent a bleeding control intervention including 18 (43.9%) nephrectomies and 11 (26.8%) angioembolizations. 18 (41%) had shattered kidney with “loss of identifiable parenchymal renal anatomy” per 2018 AAST OIS (model-1). 28 (68.3%) had concurrent VCE (model-2). Model-2 had a statistically significant improvement in area under the curve over model-1 in predicting bleeding interventions (0.75 vs. 0.72; p=0.01)
Shattered kidney is associated with high rates of active bleeding, urinary extravasation, and interventions including nephrectomy. The definition of shattered kidney is vague and subjective and our definition might be simpler and more reproducible. Loss of identifiable renal anatomy per the 2018 AAST OIS did not provide better distinction for bleeding control interventions over presence of VCE.
Details
- Title: Subtitle
- Shattered Kidney After Renal Trauma: Should it be Classified as an American Association for the Surgery of Trauma (AAST) Grade V Injury?
- Creators
- Sorena Keihani - University of UtahDouglas Rogers - University of UtahSherry S. Wang - Mayo ClinicJoel A. Gross - University of WashingtonRyan P. Joyce - University of WashingtonJudith C. Hagedorn - University of WashingtonSarah Majercik - Intermountain Medical CenterRachel L. Sensenig - Cooper University HospitalIan Schwartz - University of MinnesotaBradley A. Erickson - University of IowaRachel A. Moses - Dartmouth–Hitchcock Medical CenterJ Patrick Selph - Urology AssociatesScott Norwood - Department of Surgery, UT Health Tyler, Tyler, TX, USABrian P. Smith - Hospital of the University of PennsylvaniaChristopher M. Dodgion - Medical College of WisconsinKaushik Mukherjee - Loma Linda University Medical CenterBenjamin N. Breyer - University of California, San FranciscoNima Baradaran - The Ohio State University Wexner Medical CenterJeremy B Myers - University of UtahMulti-institutional Genito-Urinary Trauma Study Group (MiGUTS)
- Resource Type
- Journal article
- Publication Details
- Urology (Ridgewood, N.J.), Vol.179, pp.181-187
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.urology.2023.06.015
- PMID
- 37356461
- ISSN
- 0090-4295
- eISSN
- 1527-9995
- Language
- English
- Electronic publication date
- 06/23/2023
- Date published
- 09/2023
- Academic Unit
- Urology
- Record Identifier
- 9984438958902771
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