You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery III1 Apr 2012231 EXTERNAL VALIDATION OF A PROPOSED SUBSTRATIFICATION OF AAST RENAL INJURY SCALE Bradley Figler, Bahaa S. Malaeb, Bryan Voelzke, and Hunter Wessells Bradley FiglerBradley Figler Seattle, WA More articles by this author , Bahaa S. MalaebBahaa S. Malaeb Seattle, WA More articles by this author , Bryan VoelzkeBryan Voelzke Seattle, WA More articles by this author , and Hunter WessellsHunter Wessells Seattle, WA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.286AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Many intermediate-grade renal injuries can be safely managed without intervention; however, a minority of these patients require either surgical or endovascular intervention for bleeding, and the traditional AAST classification does not adequately stratify this subset of patients. Recently, a classification scheme was proposed in which these injuries are further stratified based on the presence of 2 or more of the following risk factors: perirenal hematoma rim distance (PRD) > 3.5cm, intravascular contrast extravasation (ICE), and medial renal laceration location. With this classification system, the authors successfully identified a subset of patients with AAST grade 3 or 4 injuries more likely to require intervention for hemodynamic instability. We sought to externally validate these criteria; however, we limited our analysis exclusively to those with grade 4 injuries. METHODS All patients presenting to a Level I trauma center with grade 4 renal injuries from 2003-2010 were reviewed. Stage was determined by the 1989 AAST staging criteria, which does not account for patients with segmental infarcts and no evidence of laceration. Therefore, a total of 69 patients with this injury were excluded. Patients who underwent definitive treatment for renal injury prior to radiographic imaging were also excluded. Images were individually reviewed for the presence of each of the risk factors. We identified all interventions for bleeding, including nephrectomy, renorrhaphy, and angioembolization. RESULTS A total of 88 patients with grade 4 renal injuries were identified. Mean age was 32.2 (SD 19.3), the majority (64.8%) of patients were male, and 94.7% of the injuries were blunt. Mean PRD was 1.9cm (SD 1.5cm), and ICE was present in 12 (13.64%) patients. The laceration site was medial in 36 (40.9%), lateral in 19 (21.6%), and complex (medial and lateral) in 28 (31.8%). A total of 9 patients (10.2%) underwent renal exploration, 6 (6.8%) underwent renorrhaphy, 1 (4.6%) underwent nephrectomy, and 11 (12.5%) underwent angiography/embolization for hemodynamic instability. Compared to patients with 0 or 1 risk factor, those with more than 1 risk factor were more likely to undergo renal exploration (26.3% vs 5.8%, p<0.01), renorrhaphy (21.1% vs 2.9%, p<0.01), nephrectomy (15.8% vs 1.5%, p<0.01), angiography/embolization (36.8% vs 5.8%, p<0.001), and any intervention for hemodynamic instability (63.2% vs 15.9%, p<0.001). CONCLUSIONS Among grade 4 renal injuries, PRD, ICE and the presence of a medial/complex laceration effectively predict the need for intervention for bleeding. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e95-e96 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bradley Figler Seattle, WA More articles by this author Bahaa S. Malaeb Seattle, WA More articles by this author Bryan Voelzke Seattle, WA More articles by this author Hunter Wessells Seattle, WA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...