Faculty Collaboration Database

Shattered Kidney After Renal Trauma: Should It Be Classified As an American Association for the Surgery of Trauma Grade V Injury? Urology 2023 Sep;179:181-187

Date

06/26/2023

Pubmed ID

37356461

DOI

10.1016/j.urology.2023.06.015

Scopus ID

2-s2.0-85166240825 (requires institutional sign-in at Scopus site)

Abstract

OBJECTIVE: To study the prevalence and management of shattered kidney and to evaluate if the new description of "loss of identifiable renal anatomy" in the 2018 American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) would improve the ability to predict bleeding control interventions.

METHODS: We used high-grade renal trauma data from 21 Level-1 trauma centers from 2013 to 2018. Initial CT scans were reviewed to identify shattered kidneys, defined as a kidney having ≥3 parenchymal fragments displaced by blood or fluid on cross-sectional imaging. We further categorized patients with shattered kidney in two models based on loss of identifiable renal parenchymal anatomy and presence or absence of vascular contrast extravasation (VCE). Bleeding interventions were compared between the groups.

RESULTS: From 861 high-grade renal trauma patients, 41 (4.8%) had shattered kidney injury. 25 (61%) underwent a bleeding control intervention including 18 (43.9%) nephrectomies and 11 (26.8%) angioembolizations. 18 (41%) had shattered kidney with "loss of identifiable parenchymal renal anatomy" per 2018 AAST OIS (model-1). 28 (68.3%) had concurrent VCE (model-2). Model-2 had a statistically significant improvement in area under the curve over model-1 in predicting bleeding interventions (0.75 vs 0.72; P = .01).

CONCLUSION: Shattered kidney is associated with high rates of active bleeding, urinary extravasation, and interventions including nephrectomy. The definition of shattered kidney is vague and subjective and our definition might be simpler and more reproducible. Loss of identifiable renal anatomy per the 2018 AAST OIS did not provide better distinction for bleeding control interventions over presence of VCE.

Author List

Keihani S, Rogers DM, Wang SS, Gross JA, Joyce RP, Hagedorn JC, Majercik S, Sensenig RL, Schwartz I, Erickson BA, Moses RA, Selph JP, Norwood S, Smith BP, Dodgion CM, Mukherjee K, Breyer BN, Baradaran N, Myers JB, (primary investigator), for the Multi-institutional Genito-Urinary Trauma Study Group (MiGUTS)

Author

Christopher M. Dodgion MD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Hemorrhage
Humans
Injury Severity Score
Kidney
Nephrectomy
Retrospective Studies
Tomography, X-Ray Computed
Trauma Centers
United States
Wounds, Nonpenetrating