Pd46-02 External Validation of a Nomogram to Predict Bleeding Interventions After High-grade Renal Trauma
Year: 2020
Type: article
Abstract: You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II (PD46)1 Apr 2020PD46-02 EXTERNAL VALIDATION OF A NOMOGRAM TO PREDICT BLEEDING INTERVENTIONS AFTER HIGH-GRADE RENAL TRAUMA Sorena Keihani*, Sherry Wang, Douglas Rogers, Joel Gross, Ryan Joyce, Elisa Wang, Judith Hagedorn, Alexander Nocera, J. Patrick Selph, Chirag Arya, Rachel Sensenig, Michael Rezaee, Rachel Moses, James Mercer, Shubham Gupta, Clara Castillejo Becerra, Nima Baradaran, Katie Glavin, Joshua Broghammer, Bryan Voelzke, Chong Zhang, Angela Presson, Raminder Nirula, and Jeremy Myers Sorena Keihani*Sorena Keihani* More articles by this author , Sherry WangSherry Wang More articles by this author , Douglas RogersDouglas Rogers More articles by this author , Joel GrossJoel Gross More articles by this author , Ryan JoyceRyan Joyce More articles by this author , Elisa WangElisa Wang More articles by this author , Judith HagedornJudith Hagedorn More articles by this author , Alexander NoceraAlexander Nocera More articles by this author , J. Patrick SelphJ. Patrick Selph More articles by this author , Chirag AryaChirag Arya More articles by this author , Rachel SensenigRachel Sensenig More articles by this author , Michael RezaeeMichael Rezaee More articles by this author , Rachel MosesRachel Moses More articles by this author , James MercerJames Mercer More articles by this author , Shubham GuptaShubham Gupta More articles by this author , Clara Castillejo BecerraClara Castillejo Becerra More articles by this author , Nima BaradaranNima Baradaran More articles by this author , Katie GlavinKatie Glavin More articles by this author , Joshua BroghammerJoshua Broghammer More articles by this author , Bryan VoelzkeBryan Voelzke More articles by this author , Chong ZhangChong Zhang More articles by this author , Angela PressonAngela Presson More articles by this author , Raminder NirulaRaminder Nirula More articles by this author , and Jeremy MyersJeremy Myers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000933.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A multi-institutional nomogram incorporating clinical and radiologic factors has been previously developed to predict bleeding interventions after high-grade renal trauma (HGRT). We aimed to externally validate this nomogram using multi-center data from level-1 trauma centers. METHODS: We gathered HGRT (AAST grades III-V) data from 7 Level-1 trauma centers. Patients were included with available initial CT scans. Two radiologists reviewed the images. Nomogram variables included: 1. trauma mechanism; 2. shock (SBP <90 mmHg); 3. concomitant injury (i.e. any solid organ, gastrointestinal, spinal cord, or major vascular injury, or pelvic fracture); 4. vascular contrast extravasation (VCE); 5. pararenal hematoma extension (beyond aorta on left or IVC on right or into the pelvis); and 6. hematoma rim distance (HRD, i.e. largest measure from the edge of the kidney to the hematoma). Bleeding interventions were: nephrectomy (total or partial), renorrhaphy, renal packing, and renal-related angioembolization.Mixed-effect Poisson regression was used to assess the associations. The prediction accuracy of the nomogram was assessed using the area under the receiver operating characteristic curve (AUC) and its 95% confidence interval (CI). RESULTS: A total of 297 HGRT patients with a mean age of 38.2±17.3 years were included. Injuries were grade III, IV, and V in 57%, 37%, and 6%. Trauma mechanism was blunt in 91%. Overall, 70% had concomitant injuries and 21% presented in shock. Using initial CT scans, 13% had VCE and 40% had pararenal hematoma. Mean HRD was 2.1±1.6 cm and 20% had an HRD≥3.5 cm. 44 (15%) patients underwent bleeding interventions including 26 angioembolizations and 15 nephrectomies. Presence of VCE was associated with 4.6-fold increase in risk of bleeding interventions (95% CI: 2.51–8.35). Every cm increase in HRD was associated with 43% increase in risk of bleeding interventions (RR:1.43; 95% CI: 1.23–1.66). The prediction accuracy of the nomogram based on the AUC was 0.85 (95% CI: 0.79–0.90). CONCLUSIONS: The prediction accuracy of the proposed nomogram remains high using external data. Predictive tools such as this nomogram can help to better risk stratify renal injuries, identify variables important for interventions, and to potentially reduce the number of unnecessary renal explorations. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e919-e919 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sorena Keihani* More articles by this author Sherry Wang More articles by this author Douglas Rogers More articles by this author Joel Gross More articles by this author Ryan Joyce More articles by this author Elisa Wang More articles by this author Judith Hagedorn More articles by this author Alexander Nocera More articles by this author J. Patrick Selph More articles by this author Chirag Arya More articles by this author Rachel Sensenig More articles by this author Michael Rezaee More articles by this author Rachel Moses More articles by this author James Mercer More articles by this author Shubham Gupta More articles by this author Clara Castillejo Becerra More articles by this author Nima Baradaran More articles by this author Katie Glavin More articles by this author Joshua Broghammer More articles by this author Bryan Voelzke More articles by this author Chong Zhang More articles by this author Angela Presson More articles by this author Raminder Nirula More articles by this author Jeremy Myers More articles by this author Expand All Advertisement PDF downloadLoading ...
Source: The Journal of Urology
Authors: Sorena Keihani*, Sherry Wang, Douglas Rogers, Joel Gross, Ryan Joyce, Elisa Wang, Judith Hagedorn, Alexander Nocera, J. Patrick Selph, Chirag Arya, Rachel Sensenig, Michael Rezaee, Rachel Moses, James Mercer, Shubham Gupta, Clara Castillejo Becerra, Nima Baradaran, Katie Glavin, Joshua Broghammer, Bryan Voelzke, Chong Zhang, Angela Presson, Raminder Nirula, Jeremy Myers
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3020825916