Coming Together: A Review of the American Association for the Surgery of Trauma's Updated Kidney Injury Scale to Facilitate Multidisciplinary Management

Hosein, Maryam; Paskar, Dave; Kodama, Ronald; Ditkofsky, Noah

doi:10.2214/ajr.19.21486

Cited by 12 publications

(8 citation statements)

References 23 publications

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“…Currently, however, abdominopelvic multi-detector CT (MDCT) with contrast enhancement is the imaging modality of choice for hemodynamically stable patients with genitourinary injuries. MDCT is fast, widely available, and provides anatomical and functional data [8].…”

Section: Discussionmentioning

confidence: 99%

Non-Operative Management with Angioembolization of Grade IV and V Renal Injuries in a Hybrid Emergency Room System

et al. 2021

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Renal injuries occur in more than 10% of patients who sustain blunt abdominal injuries. Non-operative management (NOM) is the established treatment strategy for lowgrade (I–III) renal injuries. However, despite some evidence that NOM can be successfully applied to high-grade (IV, V) renal injuries, it remains unclear whether NOM is appropriate in such cases. The authors report two cases of high-grade renal injuries that underwent NOM after embolization in a hybrid emergency room (ER) system with a 24/7 in-house interventional radiology (IR) team. A 29-year-old male visited Wonkwang University Hospital Regional Trauma Center complaining of right abdominal pain after being hit by a rope. Computed tomography (CT) was performed 16 minutes after arrival, and the CT scan indicated a grade V right renal injury. Arterial embolization was initiated within 31 minutes of presentation. A 56-year-old male was transferred to Wonkwang University Hospital Regional Trauma Center with a complaint of right flank pain. He had initially presented to a nearby hospital after falling from a 3-m height. Thanks to the key CT images sent from the previous hospital prior to the patient’s arrival, angiography was performed within 8 minutes of the patient’s arrival and arterial embolization was completed within 25 minutes. Both patients were treated successfully through NOM with angioembolization and preserved kidneys. Hematoma in the first patient and urinoma in the second patient resolved with percutaneous catheter drainage. The authors believe that the hybrid ER system with an in-house IR team could contribute to NOM and kidney preservation even in high-grade renal injuries.

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Section: Discussionmentioning

confidence: 99%

Non-Operative Management with Angioembolization of Grade IV and V Renal Injuries in a Hybrid Emergency Room System

et al. 2021

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“…Assessment of iatrogenic injuries is consistent with global trends – traumatic medical procedures lead to the patient’s decline in quality of life, there is a risk of incomplete recovery of the urinary system functioning even with the correct treatment tactics, as well as the risk of irreversible organ loss or the development of chronic disease [ 1 ]. The increasing complexity of medical procedures does not reduce the risk of iatrogenic injuries [ 24 ]. The more medical knowledge is accumulated and the academic interaction develops, the clearer becomes the importance of even minor incidents.…”

Section: Discussionmentioning

confidence: 99%

“…The assessment of the understanding of the urinary system organs topographic anatomy features and the risks of their injury, the typical procedural mistakes, as well as the observance of medical intervention algorithms established the main sources of iatrogenic injuries: typical procedural mistakes [ 32 ], the violation of injuries prevention algorithms [ 24 ] as well as complex clinical situations with problematic anatomical orientation and a risk of accidental damage to the urinary system organs [ 33 ]. The wide geography of the study participants demonstrates the universal nature of the problem.…”

Section: Discussionmentioning

confidence: 99%

A multidisciplinary approach to urinary system iatrogenic injuries

Белобородов

Vorobev

Голуб

et al. 2020

Cent european J Urol

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Introduction Urinary system iatrogenic injuries appear because of urological, obstetric-gynecological, and surgical manipulations in the retroperitoneal space, pelvis, or perineum. The purpose of this research was to analyze and obtain knowledge about the issue of iatrogenic injuries, to apply injury prevention algorithms, and to assess multidisciplinary perspectives in modern surgery. Material and methods The research was interdisciplinary and consisted of several modules: a prospective, single-centre study of urinary system iatrogenic injuries (476 patients) along with four interregional and international procedural types of research. Results The analysis results indicate an extremely high significance of urinary system injuries evoking numerous negative consequences that are hard to eliminate. A comparative assessment of interdisciplinary interaction demonstrates the more effective interpretation of examination results, more comprehensive and credible clinical diagnosis, more qualitative evaluation of a patient’s condition, more effective choice of initial treatment policy, and more satisfactory treatment in patients’ opinion. The research allowed for the identification of a typical procedural mistake in the urethral catheter setting causing a high risk of urethra injuries followed by urethra strictures or consecutive infections of the urinary tract. Conclusions More complicated treatment procedures cause a higher probability of urinary system iatrogenic injuries. The absence of unified algorithms and typical procedural mistakes cause such incidents. A partial solution to this issue could be found in a more profound interdisciplinary interaction in all treatment phases as well as in identifying and eliminating procedural mistakes.

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“…In line with this, reflecting the need for “continued refinement” as stipulated in the initial grading, 12 the AAST OIS for spleen, liver, and kidney were most recently revised in 2018. 6,13…”

Section: American Association For the Surgery Of Trauma Organ Injury mentioning

confidence: 99%

“…These include vascular injuries, encompassing active bleeding, pseudoaneurysms and AV fistulas, and renal collecting system injuries involving the renal pelvis and ureteropelvic junction. 6,13…”

Section: American Association For the Surgery Of Trauma Organ Injury mentioning

confidence: 99%

Changes in Approach to Solid Organ Injury: What the Radiologist Needs to Know

et al. 2020

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This review aims to examine the challenges facing radiologists interpreting trauma computed tomography (CT) images in this era of a changing approach to management of solid organ trauma. After reviewing the pearls and pitfalls of CT imaging protocols for detection of traumatic solid organ injuries, we describe the key changes in the 2018 American Association for the Surgery of Trauma Organ Injury Scales for liver, spleen, and kidney and their implications for management strategies. We then focus on the important imaging findings in observed in patients who undergo nonoperative management and patients who are imaged post damage control surgery.

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Coming Together: A Review of the American Association for the Surgery of Trauma's Updated Kidney Injury Scale to Facilitate Multidisciplinary Management

Cited by 12 publications

References 23 publications

Non-Operative Management with Angioembolization of Grade IV and V Renal Injuries in a Hybrid Emergency Room System

Non-Operative Management with Angioembolization of Grade IV and V Renal Injuries in a Hybrid Emergency Room System

A multidisciplinary approach to urinary system iatrogenic injuries

Changes in Approach to Solid Organ Injury: What the Radiologist Needs to Know

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