Journal article
The American Association for the Surgery of Trauma renal injury grading scale: Implications of the 2018 revisions for injury reclassification and predicting bleeding interventions
The journal of trauma and acute care surgery, Vol.88(3), pp.357-365
03/01/2020
DOI: 10.1097/TA.0000000000002572
PMID: 31876692
Abstract
BACKGROUND In 2018, the American Association for the Surgery of Trauma (AAST) published revisions to the renal injury grading system to reflect the increased reliance on computed tomography scans and non-operative management of high-grade renal trauma (HGRT). We aimed to evaluate how these revisions will change the grading of HGRT and if it outperforms the original 1989 grading in predicting bleeding control interventions. METHODS Data on HGRT were collected from 14 Level-1 trauma centers from 2014 to 2017. Patients with initial computed tomography scans were included. Two radiologists reviewed the scans to regrade the injuries according to the 1989 and 2018 AAST grading systems. Descriptive statistics were used to assess grade reclassifications. Mixed-effect multivariable logistic regression was used to measure the predictive ability of each grading system. The areas under the curves were compared. RESULTS Of the 322 injuries included, 27.0% were upgraded, 3.4% were downgraded, and 69.5% remained unchanged. Of the injuries graded as III or lower using the 1989 AAST, 33.5% were upgraded to grade IV using the 2018 AAST. Of the grade V injuries, 58.8% were downgraded using the 2018 AAST. There was no statistically significant difference in the overall areas under the curves between the 2018 and 1989 AAST grading system for predicting bleeding interventions (0.72 vs. 0.68,p= 0.34). CONCLUSION About one third of the injuries previously classified as grade III will be upgraded to grade IV using the 2018 AAST, which adds to the heterogeneity of grade IV injuries. Although the 2018 AAST grading provides more anatomic details on injury patterns and includes important radiologic findings, it did not outperform the 1989 AAST grading in predicting bleeding interventions.
Details
- Title: Subtitle
- The American Association for the Surgery of Trauma renal injury grading scale: Implications of the 2018 revisions for injury reclassification and predicting bleeding interventions
- Creators
- Sorena Keihani - University of UtahDouglas M. Rogers - University of UtahBryn E. Putbrese - University of UtahRoss E. Anderson - University of UtahGregory J. Stoddard - University of UtahRaminder Nirula - University of UtahXian Luo-Owen - Loma Linda University Health CareKaushik Mukherjee - Loma Linda University Health CareBradley J. Morris - Loma Linda UniversitySarah Majercik - Loma Linda UniversityJoshua Piotrowski - Medical College of WisconsinChristopher M. Dodgion - Medical College of WisconsinIan Schwartz - University of MinnesotaSean P. Elliott - University of MinnesotaErik S. DeSoucy - University of California, DavisScott Zakaluzny - University of California, DavisBrenton G. Sherwood - University of IowaBradley A. Erickson - University of IowaNima Baradaran - The Ohio State UniversityBenjamin N. Breyer - University of California, San FranciscoCameron N. Fick - University of PennsylvaniaBrian P. Smith - University of PennsylvaniaBarbara U. Okafor - Harvard UniversityReza Askari - Harvard UniversityBrandi D. Miller - Detroit Medical CenterRichard A. Santucci - Detroit Medical CenterMatthew M. CarrickLaDonna Allen - UT Hlth Tyler, Dept Surg, Tyler, TX USAScott Norwood - The University of Texas Health Science Center at TylerTimothy Hewitt - Oakland UniversityFrank N. Burks - Oakland UniversityMarta E. Heilbrun - Emory UniversityJoel A. Gross - University of WashingtonJeremy B. Myers - University of UtahTrauma and Urologic Reconstruction Network of Surgeons
- Resource Type
- Journal article
- Publication Details
- The journal of trauma and acute care surgery, Vol.88(3), pp.357-365
- DOI
- 10.1097/TA.0000000000002572
- PMID
- 31876692
- NLM abbreviation
- J Trauma Acute Care Surg
- ISSN
- 2163-0755
- eISSN
- 2163-0763
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 9
- Grant note
- National Center for Research Resources; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Research Resources (NCRR) 5UL1TR001067-05 / National Center for Advancing Translational Sciences, National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Advancing Translational Sciences (NCATS) University of Utah Study Design and Biostatistics Center
- Language
- English
- Date published
- 03/01/2020
- Academic Unit
- Urology
- Record Identifier
- 9984320072102771
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