Sorena Keihani1, Douglas M Rogers, Bryn E Putbrese, Ross E Anderson, Gregory J Stoddard, Raminder Nirula, Xian Luo-Owen, Kaushik Mukherjee, Bradley J Morris, Sarah Majercik, Joshua Piotrowski, Christopher M Dodgion, Ian Schwartz, Sean P Elliott, Erik S DeSoucy, Scott Zakaluzny, Brenton G Sherwood, Bradley A Erickson, Nima Baradaran, Benjamin N Breyer, Cameron N Fick, Brian P Smith, Barbara U Okafor, Reza Askari, Brandi D Miller, Richard A Santucci, Matthew M Carrick, LaDonna Allen, Scott Norwood, Timothy Hewitt, Frank N Burks, Marta E Heilbrun, Joel A Gross, Jeremy B Myers. 1. From the Division of Urology, Department of Surgery (S.K., R.E.A., J.B.M.), Department of Radiology (D.M.R., B.E.P.), Division of Epidemiology, Department of Internal Medicine (G.J.S.), 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.), Department of Surgery (C.M.D.), Medical College 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.), 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.), The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Urology (B.N.B.), University of California-San Francisco, San Francisco, California; Division of Trauma and Surgical Critical Care (C.N.F., 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.D.M., R.A.S.), Detroit Medical Center, Detroit, Michigan; Medical City Plano (M.M.C.), Plano; Department of Surgery (L.A., S.N.), UT Health Tyler, 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, Georgia; and Department of Radiology (J.A.G.), University of Washington, Seattle, Washington.
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. LEVEL OF EVIDENCE: Prognostic and Epidemiological Study, level III.
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. LEVEL OF EVIDENCE: Prognostic and Epidemiological Study, level III.
Authors: Sorena Keihani; Sherry S Wang; Ryan P Joyce; Douglas M Rogers; Joel A Gross; Alexander P Nocera; J Patrick Selph; Elisa Fang; Judith C Hagedorn; Bryan B Voelzke; Michael E Rezaee; Rachel A Moses; Chirag S Arya; Rachel L Sensenig; Katie Glavin; Joshua A Broghammer; Margaret M Higgins; Shubham Gupta; Clara M Castillejo Becerra; Nima Baradaran; Chong Zhang; Angela P Presson; Raminder Nirula; Jeremy B Myers Journal: J Trauma Acute Care Surg Date: 2021-02-01 Impact factor: 3.313