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• W2000993631 abstract "No AccessJournal of UrologyAdult Urology1 Feb 2010American Association for the Surgery of Trauma Grade 4 Renal Injury Substratification Into Grades 4a (Low Risk) and 4b (High Risk) Daniel D. Dugi, Allen F. Morey, Amit Gupta, Geoffrey R. Nuss, Geraldine L. Sheu, and Jeffrey H. Pruitt Daniel D. DugiDaniel D. Dugi More articles by this author , Allen F. MoreyAllen F. Morey Financial interest and/or other relationship with GlaxoSmithKline, Pfizer, AMS and Baxter. More articles by this author , Amit GuptaAmit Gupta More articles by this author , Geoffrey R. NussGeoffrey R. Nuss More articles by this author , Geraldine L. SheuGeraldine L. Sheu More articles by this author , and Jeffrey H. PruittJeffrey H. Pruitt More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2009.10.015AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We identified computerized tomography findings associated with the need for urgent intervention for hemostasis after traumatic renal injury to update and refine the American Association for the Surgery of Trauma Organ Injury Scale for renal trauma. Materials and Methods: We retrospectively reviewed the records of consecutive patients presenting to our level I trauma center from 1999 to 2008 with American Association for the Surgery of Trauma grades 3 and 4 renal injury. In all patients initial abdominal computerized tomography was done soon after presentation to the emergency department before renal intervention. All images were interpreted by a staff radiologist and urologist blinded to clinical outcomes. Novel radiographic features (perirenal hematoma size, intravascular contrast extravasation and renal laceration site) were analyzed and correlated with the invasive intervention rate to control life threatening bleeding. Results: Of 299 patients hospitalized with renal injury 102 met study inclusion criteria. Increased perirenal hematoma size (perirenal hematoma rim distance greater than 3.5 cm), intravascular contrast extravasation and a medial renal laceration site were important radiographic risk factors significantly associated with intervention for bleeding after renal trauma. Analyzing these radiographic characteristics collectively showed that patients with 0 or 1 risk factor were at 7.1% risk for intervention and those with 2 or 3 were at remarkably higher risk, that is 66.7% (OR 26.0, 95% CI 7.20–93.9, p <0.0001). Conclusions: On radiography a large perirenal hematoma, intravascular contrast extravasation and medial renal laceration are important risk factors associated with the need for urgent hemostatic intervention after renal trauma. Assessing these computerized tomography characteristics collectively shows that American Association for the Surgery of Trauma grade 4 renal injuries can and should be substratified into grades 4a (low risk) and 4b (high risk). References 1 : Organ injury scaling: spleen, liver, and kidney. J Trauma1989; 29: 1664. Crossref, Medline, Google Scholar 2 : American Association for the Surgery of Trauma organ injury scale for kidney injuries predicts, nephrectomy, dialysis, and death in patients with blunt injury and nephrectomy for penetrating injuries. J Trauma2006; 60: 351. Google Scholar 3 : Validation of the American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma2001; 50: 195. 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Link, Google Scholar Departments of Urology and Radiology (JHP), University of Texas Southwestern Medical Center, Dallas, Texas© 2010 by American Urological AssociationFiguresReferencesRelatedDetailsCited byKeihani S, Gross J, Joyce R, Wang S, Rogers D, Fang E, Hagedorn J, Voelzke B, Nocera A, Selph J, Rezaee M, Moses R, Arya C, Sensenig R, Glavin K, Broghammer J, Higgins M, Gupta S, Castillejo Becerra C, Baradaran N, Kozar R, Nirula R and Myers J (2020) The American Association for the Surgery of Trauma Renal Grading System—Should Segmental Kidney Infarction be Classified as a Grade IV Injury?Journal of Urology, VOL. 205, NO. 1, (165-173), Online publication date: 1-Jan-2021.Ballon-Landa E, Raheem O, Fuller T, Kobayashi L and Buckley J (2019) Renal Trauma Classification and Management: Validating the Revised Renal Injury Grading ScaleJournal of Urology, VOL. 202, NO. 5, (994-1000), Online publication date: 1-Nov-2019.Keihani S and Myers J (2018) Re: Perinephric Hematoma Size is Independently Associated with the Need for Urological Intervention in Multisystem Blunt Renal TraumaJournal of Urology, VOL. 200, NO. 3, (656-657), Online publication date: 1-Sep-2018.Zemp L, Mann U and Rourke K (2018) Perinephric Hematoma Size is Independently Associated with the Need for Urological Intervention in Multisystem Blunt Renal TraumaJournal of Urology, VOL. 199, NO. 5, (1283-1288), Online publication date: 1-May-2018.Husmann D (2014) Grade IV Renal Trauma Managed in a Nonoperative Fashion—Is There a Benefit to Preemptive Endoscopic and/or Radiographic Intervention?Journal of Urology, VOL. 192, NO. 2, (299-300), Online publication date: 1-Aug-2014.Morey A, Brandes S, Dugi D, Armstrong J, Breyer B, Broghammer J, Erickson B, Holzbeierlein J, Hudak S, Pruitt J, Reston J, Santucci R, Smith T and Wessells H (2014) Urotrauma: AUA GuidelineJournal of Urology, VOL. 192, NO. 2, (327-335), Online publication date: 1-Aug-2014.Morey A (2013) Re: Computed Tomographic Imaging in Determining the Need of Embolization for High-Grade Blunt Renal InjuryJournal of Urology, VOL. 190, NO. 1, (171-171), Online publication date: 1-Jul-2013.Hardee M, Lowrance W, Brant W, Presson A, Stevens M and Myers J (2012) High Grade Renal Injuries: Application of Parkland Hospital Predictors of Intervention for Renal HemorrhageJournal of Urology, VOL. 189, NO. 5, (1771-1776), Online publication date: 1-May-2013.Fiard G, Rambeaud J, Descotes J, Boillot B, Terrier N, Thuillier C, Chodez M, Skowron O, Berod A, Arnoux V and Long J (2012) Long-Term Renal Function Assessment With Dimercapto-Succinic Acid Scintigraphy After Conservative Treatment of Major Renal TraumaJournal of Urology, VOL. 187, NO. 4, (1306-1309), Online publication date: 1-Apr-2012.Morey A (2011) Re: What are the Specific Computed Tomography Scan Criteria That Can Predict or Exclude the Need for Renal Angioembolization After High-Grade Renal Trauma in a Conservative Management Strategy?Journal of Urology, VOL. 187, NO. 2, (554-554), Online publication date: 1-Feb-2012.Hotaling J, Wang J, Sorensen M, Rivara F, Gore J, Jurkovich J, McClung C, Wessells H and Voelzke B (2011) A National Study of Trauma Level Designation and Renal Trauma OutcomesJournal of Urology, VOL. 187, NO. 2, (536-541), Online publication date: 1-Feb-2012. Volume 183Issue 2February 2010Page: 592-597 Advertisement Copyright & Permissions© 2010 by American Urological AssociationKeywordstomographywounds and injurieshematomarisk assessmentemission-computedkidneyMetricsAuthor Information Daniel D. Dugi More articles by this author Allen F. Morey Financial interest and/or other relationship with GlaxoSmithKline, Pfizer, AMS and Baxter. More articles by this author Amit Gupta More articles by this author Geoffrey R. Nuss More articles by this author Geraldine L. Sheu More articles by this author Jeffrey H. Pruitt More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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