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J Urol. 2019 May 30:101097JU0000000000000358. doi: 10.1097/JU.0000000000000358. [Epub ahead of print]

Renal trauma classification and management validating the revised Renal Injury Grading Scale.

Author information

1
Department of Urology, University of California San Diego , San Diego , California.
2
Department of Urology, Tulane University , New Orleans , Louisiana.
3
Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego , San Diego , California.

Abstract

PURPOSE:

To better characterize traumatic renal injury a revision to the 1989 American Association for the Surgery of Trauma Renal Injury Scale was proposed in which grade IV includes all collecting system and segmental vascular injuries, and grade V includes main renal hilar injury. We sought to validate the 2009 grading scale, emphasizing reclassifications between the 1989 and 2009 versions and subsequent management.

MATERIALS AND METHODS:

Using a prospective trauma database, patient demographics and renal injury characteristics, computerized tomography imaging, radiology reports, and subsequent management were recorded. Multivariable logistic regression models for intervention were compared using 1989 and 2009 grades to evaluate which grading scale better predicted management.

RESULTS:

Among 256 cases of renal injury, 56 (21.9%) were reclassified using the revised 2009 scale; 50 cases (19.5%) were upgraded, 6 (2.3%) were downgraded, and 200 (78.1%) were unchanged. Among cases with grades III or higher, 112 (78.9%) were managed non-operatively, 9 (6.3%) with angioembolization, 9 (6.3%) with nephrectomy, and 12 (8.5%) with renorrhaphy; management was significantly associated with original and revised grade (Χ2, p=0.02 and p<0.001, respectively). Further, the multivariable model using the 2009 grades significantly outperformed the 1989 model. Radiology reports rarely included renal injury scales.

CONCLUSIONS:

Employing the revised renal injury grading scale led to more definitive classification of renal injury and a stronger association with renal trauma management. Applying the revised criteria may facilitate and improve the multidisciplinary care of renal trauma.

KEYWORDS:

injury severity scale; management; radiology report; renal trauma

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