E1394. Review of the Renal Trauma Grading System with Perspectives of Early Urologic Involvement in the Emergency Room for Grade 3 and 4 Injuries
Authors
Toliver Freeman;
Louisiana State University Health Sciences Center School of Medicine
Ardenne Martin;
Louisiana State University Health Sciences Center School of Medicine
Francisco Brito Encarnacion;
Louisiana State University Health Sciences Center School of Medicine
Crawford Dixon;
Louisiana State University Health Sciences Center School of Medicine
Catherine Batte;
Louisiana State University Health Sciences Center School of Medicine
Eric Wallace;
Louisiana State University Health Sciences Center School of Medicine
Bradley Spieler ;
Louisiana State University Health Sciences Center School of Medicine
Background
In general, an interdisciplinary approach to the management of renal trauma that utilizes urologic consultation is associated with increased renal preservation in circumstances where nephrectomy is being considered. Renal trauma management resulting in nephrectomy should be avoided, when possible, as recent data suggests an acquired solitary kidney increases the odds of mortality and relative risk of developing end-stage renal disease. This educational exhibit aims to review the American Association for the Surgery of Trauma (AAST) renal trauma grading system that was most recently updated in 2018. This exhibit also discusses the clinical impact of a urologic consultation during the acute management of grade III and grade IV renal injuries.
Educational Goals / Teaching Points
Review the AAST renal injury grade scale by providing case-based examples of the various injury types. Review current implications for managing renal traumas based on the given grade. Highlight the utility of urologic consultation in the management of grade III and grade IV renal traumas by discussing preliminary data.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We will review the key factors to consider in differentiating the various AAST renal injury grades. The presence or absence of several integral radiologic features such as renal hilar injury, urinary extravasation, vascular extravasation, and qualities of associated perirenal hematomas will be exhibited via computed tomography. The purpose is to assist the radiologist in the recognition of these key imaging features and to ultimately guide consultation as well as management of renal injury. There will be a focus on the AAST grades III and IV injuries because these have been associated with the most variable treatment options in recent literature.
Conclusion
Our preliminary data show an inverse correlation between the frequency of nephrectomy and urologic consultation during the initial management of grade III and grade IV renal traumas in the emergency room. Our study suggests that urologic consultation should be considered when emergently managing grade III and IV renal traumas in which nephrectomy is a therapeutic possibility.
