262 / Urology

injury. Segmental vascular injuries with or without collecting system injury are

classified as grade IV. Regardless of the staging system, a hemodynamically

unstable patient who does not require exploration for other organ injuries embo-

lization can effectively control bleeding. The end point with main renal artery

embolization is essentially the same as that with exploration and nephrectomy.

The major limitation of this study is that the authors follow-up is solely based

on a patient questionnaire. None of the patients had a physical examination or

laboratory test to assess renal function. There is no radiographic follow-up

after initial hospital discharge. Based on this, we can conclude that embolization

is safe in the short term and does not seem to be associated with any clinically

apparent long-term sequelae.

D. E. Coplen, MD

Revision of Current American Association for the Surgery of Trauma RenalInjury Grading SystemBuckley JC, McAninch JW (Lahey Clinic Med Ctr, Burlington, MA; San

Francisco General Hosp, CA)

J Trauma 70:35-37, 2011

Background.dWe propose a revision of the original 1989 renal organinjury system established by the American Association for the Surgery ofTrauma based on our institutions >25-year longitudinal experience. Ourgoal is to expand the current grading system to include segmental vascularinjuries and ureteral pelvic injuries and to establish a more rigorous defi-nition of severe grade IV and V renal injuries.Methods.dWe retrospectively reviewed our prospectively gathered

contiguous renal database of 3,580 renal injuries to describe a revisedrenal grading injury scale based on clinical renal salvage outcomes. Wefocused on themechanism of injury, the stability of the patient, radiographicimaging, associated nonrenal injuries, and clinical salvage outcome data.Results.dNo changesweremade in the definition of grade I to III injuries.

The revised grade IV classification includes all collecting system, renal pelvisinjuries and segmental arterial and/or venous injuries. The revised grade Vclassification is limited to main renal artery and/or vein injuries, includinglaceration, avulsion, and thrombosis. We compared the nephrectomy rateand clinical renal salvage rate between the original 1989 renal organ injurysystem with our revised renal injury staging classification.Conclusion.dThe revised renal injury staging classification provides

complete and clear definitions of renal trauma while still performing itsfundamental objective to reflect increasingly complex renal injuries.Uniform language and classification of renal injuries will enhance discus-sion, clinical investigation, and research of renal trauma.

:

The authors revise the renal injury staging classification. Improved imaging

technology allows more accurate identification of the location and severity of

renal injury. There is no collecting system injury in grades I, II, and III injuries.

Chapter 28eTrauma / 263

In grade III injury, the renal laceration is greater than 1 cm and into the renal

medulla. Grade IV is now any collecting system injury or segmental venous or

arterial injury. Previously, grade V was the somewhat nebulous shattered

kidney. It now includes only vascular injuries to the renal pedicle. A kidney

with grade V injury is almost never salvageable because of time delays between

injury and evaluation. Because most renal injuries are grade I, this new classi-

fication will likely impact only the management of the most serious renal

injuries.

D. E. Coplen, MD

Revision of Current American Association for the Surgery of Trauma Renal Injury Grading System