Updated Kidney Organ Injury Scale

Description

Kozar et al reported an updated injury scale for renal trauma

Detection may be based on CT, operative or pathologic findings

Parameters:

(1) subcapsular hematoma

(2) parenchymal contusion without laceration

(3) parenchymal laceration

(4) perirenal hematoma or bleeding

(5) vascular injury

(6) ureteropelvic disruption

(7) shattered kidney

Parameter	Finding	AAST Grade
subcapsular hematoma	no	0
	yes	I
parenchymal contusion	no	0
	yes	I
parenchymal laceration	no	0
	<= 1 cm deep and no urinary extravasation	II
	> 1 cm deep without urinary extravasation or collecting system rupture	III
	extending into urinary collecting system with urinary extravasation	IV
	involving renal pelvis	IV
perirenal hematoma	no	0
	confined to Gerota's fascia	II
	active bleeding beyond Gerota's fascia into retroperitoneum or peritoneum	IV
vascular injury/bleeding	none	0
	vascular injury or active bleeding contained within Gerota's fascia	III
	injury to segmental renal vein or artery	IV
	segmental or complete renal infarction due to thrombosis	IV
	main renal artery or vein laceration or avulsion at hilum	V
	devascularized kidney with active bleeding	V
ureteropelvic disruption	no	0
	yes	IV
shattered kidney	no	0
	yes	V

If there are multiple injuries then increased grade by 1, up to Grade III (presumably refers to multiple Grade I or II lesions).

If more than one grade of injury is present then classify based by the higher/highest grade.

Vascular thrombosis can lead to organ infarction.

Vascular injury is defined as a pseudoaneurysm or arteriovenous fistula and appears as a focal collection of vascular contrast that decreases in attenuation with later images.

Active bleeding in images with contrast show an increase in size or attenuation with delayed images.

AAST Grade	AIS Severity
I	2
II	2
III	3
IV	4
V	5

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