TY - JOUR
T1 - A nomogram predicting the need for bleeding interventions after high-grade renal trauma
T2 - Results from the American Association for the Surgery of Trauma Multi-institutional Genito-Urinary Trauma Study (MiGUTS)
AU - in conjunction with the Trauma and Urologic Reconstruction Network of Surgeons
AU - Keihani, Sorena
AU - Rogers, Douglas M.
AU - Putbrese, Bryn E.
AU - Moses, Rachel A.
AU - Zhang, Chong
AU - Presson, Angela P.
AU - Hotaling, James M.
AU - Nirula, Raminder
AU - Luo-Owen, Xian
AU - Mukherjee, Kaushik
AU - Morris, Bradley J.
AU - Majercik, Sarah
AU - Piotrowski, Joshua
AU - Dodgion, Christopher M.
AU - Schwartz, Ian
AU - Elliott, Sean P.
AU - Desoucy, Erik S.
AU - Zakaluzny, Scott
AU - Sherwood, Brenton G.
AU - Erickson, Bradley A.
AU - Baradaran, Nima
AU - Breyer, Benjamin N.
AU - Smith, Brian P.
AU - Okafor, Barbara U.
AU - Askari, Reza
AU - Miller, Brandi
AU - Santucci, Richard A.
AU - Carrick, Matthew M.
AU - Kocik, Jurek F.
AU - Hewitt, Timothy
AU - Burks, Frank N.
AU - Heilbrun, Marta E.
AU - Myers, Jeremy B.
N1 - Funding Information:
This study was not directly supported by any industrial or federal funds. The investigation was in part supported by the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through grant 5UL1TR001067-05 (formerly 8UL1TR000105 and UL1RR025764).
Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - BACKGROUND The management of high-grade renal trauma (HGRT) and the indications for intervention are not well defined. The American Association for the Surgery of Trauma (AAST) renal grading does not incorporate some important clinical and radiologic variables associated with increased risk of interventions. We aimed to use data from a multi-institutional contemporary cohort to develop a nomogram predicting risk of interventions for bleeding after HGRT. METHODS From 2014 to 2017, data on adult HGRT (AAST grades III-V) were collected from 14 level 1 trauma centers. Patients with both clinical and radiologic data were included. Data were gathered on demographics, injury characteristics, management, and outcomes. Clinical and radiologic parameters, obtained after trauma evaluation, were used to predict renal bleeding interventions. We developed a prediction model by applying backward model selection to a logistic regression model and built a nomogram using the selected model. RESULTS A total of 326 patients met the inclusion criteria. Mechanism of injury was blunt in 81%. Median age and injury severity score were 28 years and 22, respectively. Injuries were reported as AAST grades III (60%), IV (33%), and V (7%). Overall, 47 (14%) underwent interventions for bleeding control including 19 renal angioembolizations, 16 nephrectomies, and 12 other procedures. Of the variables included in the nomogram, a hematoma size of 12 cm contributed the most points, followed by penetrating trauma mechanism, vascular contrast extravasation, pararenal hematoma extension, concomitant injuries, and shock. The area under the receiver operating characteristic curve was 0.83 (95% confidence interval, 0.81-0.85). CONCLUSION We developed a nomogram that integrates multiple clinical and radiologic factors readily available upon assessment of patients with HGRT and can provide predicted probability for bleeding interventions. This nomogram may help in guiding appropriate management of HGRT and decreasing unnecessary interventions.
AB - BACKGROUND The management of high-grade renal trauma (HGRT) and the indications for intervention are not well defined. The American Association for the Surgery of Trauma (AAST) renal grading does not incorporate some important clinical and radiologic variables associated with increased risk of interventions. We aimed to use data from a multi-institutional contemporary cohort to develop a nomogram predicting risk of interventions for bleeding after HGRT. METHODS From 2014 to 2017, data on adult HGRT (AAST grades III-V) were collected from 14 level 1 trauma centers. Patients with both clinical and radiologic data were included. Data were gathered on demographics, injury characteristics, management, and outcomes. Clinical and radiologic parameters, obtained after trauma evaluation, were used to predict renal bleeding interventions. We developed a prediction model by applying backward model selection to a logistic regression model and built a nomogram using the selected model. RESULTS A total of 326 patients met the inclusion criteria. Mechanism of injury was blunt in 81%. Median age and injury severity score were 28 years and 22, respectively. Injuries were reported as AAST grades III (60%), IV (33%), and V (7%). Overall, 47 (14%) underwent interventions for bleeding control including 19 renal angioembolizations, 16 nephrectomies, and 12 other procedures. Of the variables included in the nomogram, a hematoma size of 12 cm contributed the most points, followed by penetrating trauma mechanism, vascular contrast extravasation, pararenal hematoma extension, concomitant injuries, and shock. The area under the receiver operating characteristic curve was 0.83 (95% confidence interval, 0.81-0.85). CONCLUSION We developed a nomogram that integrates multiple clinical and radiologic factors readily available upon assessment of patients with HGRT and can provide predicted probability for bleeding interventions. This nomogram may help in guiding appropriate management of HGRT and decreasing unnecessary interventions.
KW - Renal trauma
KW - computed tomography
KW - conservative treatment
KW - multicenter study
KW - nephrectomy
KW - nomograms
KW - trauma centers
KW - wounds and injuries
UR - http://www.scopus.com/inward/record.url?scp=85065069715&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85065069715&partnerID=8YFLogxK
U2 - 10.1097/TA.0000000000002222
DO - 10.1097/TA.0000000000002222
M3 - Article
C2 - 30741884
AN - SCOPUS:85065069715
SN - 2163-0755
VL - 86
SP - 774
EP - 782
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 5
ER -