Keihani et al reported a nomogram for identifying a patient with high-grade renal trauma who may require an intervention to control renal bleeding. The authors are from multiple institutions participating in the American Association for the Surgery of Trauma Multi-institutional Genito-Urinary Trauma Study.
Patient selection: high-grade renal trauma (Grade 3, 4 or 5)
Outcome: need for an intervention to control bleeding (angioembolization, nephrectomy, etc)
Parameters:
(1) mechanism of injury (penetrating or blunt)
(2) hypotension or shock
(3) concomitant injuries
(4) extravasation of vascular contrast material
(5) para-renal hematoma
(6) hematoma rim distance in cm (the largest measure from the edge of the kidney to the rim of the hematoma)
|
Parameter
|
Finding
|
Points
|
|
mechanism of injury
|
blunt
|
0
|
|
|
penetrating
|
34
|
|
hypotension or shock
|
no
|
0
|
|
|
yes
|
16
|
|
concomitant injuries
|
no
|
0
|
|
|
yes
|
16.5
|
|
extravasation of contrast material
|
no
|
0
|
|
|
yes
|
29
|
|
para-renal hematoma
|
no
|
0
|
|
|
yes
|
20
|
points for hematoma rim distance =
= MIN(100,8.333*(rim distance))
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 215.5
• The higher the score the greater the risk of requiring an intervention for bleeding.
X =
= (0.04632 * (score)) - 5.119
probability of an intervention for bleeding =
= 1/ (1+EXP((-1) * X))
