Reliability Of The American Association For The Surgery Of Trauma (Aast) Renal Injury Grading For High-Grade Renal Injuries

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) (MP04)1 Apr 2019MP04-02 RELIABILITY OF THE AMERICAN ASSOCIATION FOR THE SURGERY OF TRAUMA (AAST) RENAL INJURY GRADING FOR HIGH-GRADE RENAL INJURIES Sorena Keihani*, Bryn Putbrese, Douglas Rogers, Gregory Stoddard, Kaushik Mukherjee, Sarah Majercik, Joshua Piotrowski, Christopher Dodgion, Brenton Sherwood, Bradley Erickson, Ian Schwartz, Sean Elliott, Erik DeSoucy, Scott Zakaluzny, Nima Baradaran, Benjamin Breyer, Brian Smith, Brandi Miller, Richard Santucci, Matthew Carrick, Jurek Kocik, Timothy Hewitt, Frank Burks, Marta Heilbrun, Raminder Nirula, James Hotaling, and Jeremy Myers Sorena Keihani*Sorena Keihani* More articles by this author , Bryn PutbreseBryn Putbrese More articles by this author , Douglas RogersDouglas Rogers More articles by this author , Gregory StoddardGregory Stoddard More articles by this author , Kaushik MukherjeeKaushik Mukherjee More articles by this author , Sarah MajercikSarah Majercik More articles by this author , Joshua PiotrowskiJoshua Piotrowski More articles by this author , Christopher DodgionChristopher Dodgion More articles by this author , Brenton SherwoodBrenton Sherwood More articles by this author , Bradley EricksonBradley Erickson More articles by this author , Ian SchwartzIan Schwartz More articles by this author , Sean ElliottSean Elliott More articles by this author , Erik DeSoucyErik DeSoucy More articles by this author , Scott ZakaluznyScott Zakaluzny More articles by this author , Nima BaradaranNima Baradaran More articles by this author , Benjamin BreyerBenjamin Breyer More articles by this author , Brian SmithBrian Smith More articles by this author , Brandi MillerBrandi Miller More articles by this author , Richard SantucciRichard Santucci More articles by this author , Matthew CarrickMatthew Carrick More articles by this author , Jurek KocikJurek Kocik More articles by this author , Timothy HewittTimothy Hewitt More articles by this author , Frank BurksFrank Burks More articles by this author , Marta HeilbrunMarta Heilbrun More articles by this author , Raminder NirulaRaminder Nirula More articles by this author , James HotalingJames Hotaling More articles by this author , and Jeremy MyersJeremy Myers More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000554954.23774.d5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: The American Association for the Surgery of Trauma (AAST) injury scale is the most widely used grading system for renal trauma. However, reproducibility of the AAST grading is not well studied. We aimed to assess the agreement for AAST renal trauma grading between radiologists and the grades entered in a multi-center database of high-grade renal trauma. METHODS: Data on high-grade renal trauma (AAST grades III-V) was collected from 14 Level-1 trauma centers from 2014-2017. Patients with initial CT scans were included. 2 radiologists, blinded to the submitted AAST grades and outcomes, reviewed the scans and re-graded the injuries according to the 1989 original AAST grading (O-AAST). After measuring the inter-radiologist agreement, both radiologists were asked to reach consensus on the discrepancies. The reproducibility of AAST grading was evaluated using weighted Kappa analysis for ordinal variables. Inter-radiologists agreement as well as final agreement between re-graded readings (O-AAST) and the injury grades submitted by the centers (C-AAST) were measured. Agreement was interpreted based on the kappa coefficient as slight (0-0.20), fair (0.21-0.40), moderate (0.41-0.60), substantial (0.61-0.80), and almost perfect (0.81-1.00). RESULTS: 322 patients met the inclusion criteria. Injuries were submitted by centers as grade III (59.8%), grade IV (33.1%), and grade V (7.1%). Upon re-grading the injuries, inter-radiologist agreement was substantial for O-AAST (Kappa: 0.76, 95% CI: 0.66-0.84). After resolving the discrepancies, injuries were re-graded using the O-AAST as non-gradable (1.2%), grade I (0.9%), grade II (4.6%), grade III (71.5%), grade IV (16.6%), and grade V (5.2%). Comparing the O-AAST re-grading and C-AAST, the agreement was moderate (Kappa: 0.50, 95% CI: 0.40-0.60). Overall, 27% of injuries were downgraded, 5% were upgraded, and 68% remained the same. CONCLUSIONS: The agreement between center-reported renal injury grades and re-grading of injuries by radiologists blinded to the outcomes was moderate and many injuries were downgraded. These findings have implications for using AAST grading for both predicting the need for interventions, as well as using administrative data, such as the National Trauma Databank for research purposes when AAST grade is an important variable. Source of Funding: none Salt Lake City, UT; Loma Linda, CA; Murray, UT; Milwaukee, WI; Iowa City, IA; Minneapolis, MN; Sacramento, CA; San Francisco, CA; Philadelphia, PA; Detroit, MI; Plano, TX; Tyler, TX; Royal Oak, MI; Atlanta, GA; Salt Lake City, UT© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e30-e30 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sorena Keihani* More articles by this author Bryn Putbrese More articles by this author Douglas Rogers More articles by this author Gregory Stoddard More articles by this author Kaushik Mukherjee More articles by this author Sarah Majercik More articles by this author Joshua Piotrowski More articles by this author Christopher Dodgion More articles by this author Brenton Sherwood More articles by this author Bradley Erickson More articles by this author Ian Schwartz More articles by this author Sean Elliott More articles by this author Erik DeSoucy More articles by this author Scott Zakaluzny More articles by this author Nima Baradaran More articles by this author Benjamin Breyer More articles by this author Brian Smith More articles by this author Brandi Miller More articles by this author Richard Santucci More articles by this author Matthew Carrick More articles by this author Jurek Kocik More articles by this author Timothy Hewitt More articles by this author Frank Burks More articles by this author Marta Heilbrun More articles by this author Raminder Nirula More articles by this author James Hotaling More articles by this author Jeremy Myers More articles by this author Expand All Advertisement PDF downloadLoading ...