The American Association for the Surgery of Trauma renal injury grading scale: Implications of the 2018 revisions for injury reclassification and predicting bleeding interventions

Sorena Keihani, Douglas M. Rogers, Bryn E. Putbrese, Ross E. Anderson, Gregory J. Stoddard, Raminder Nirula, Xian Luo-Owen, Kaushik Mukherjee, Bradley J. Morris, Sarah Majercik, Joshua Piotrowski, Christopher M. Dodgion, Ian Schwartz, Sean P. Elliott, Erik S. DeSoucy, Scott Zakaluzny, Brenton G. Sherwood, Bradley A. Erickson, Nima Baradaran, Benjamin N. BreyerCameron N. Fick, Brian P. Smith, Barbara U. Okafor, Reza Askari, Brandi D. Miller, Richard A. Santucci, Matthew M. Carrick, La Donna Allen, Scott Norwood, Timothy Hewitt, Frank N. Burks, Marta E. Heilbrun, Joel A. Gross, Jeremy B. Myers

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


BACKGROUND: In 2018, the American Association for the Surgery of Trauma (AAST) published revisions to the renal injury grading system to reflect the increased reliance on computed tomography scans and non-operative management of high-grade renal trauma (HGRT). We aimed to evaluate how these revisions will change the grading of HGRT and if it outperforms the original 1989 grading in predicting bleeding control interventions.

METHODS: Data on HGRT were collected from 14 Level-1 trauma centers from 2014 to 2017. Patients with initial computed tomography scans were included. Two radiologists reviewed the scans to regrade the injuries according to the 1989 and 2018 AAST grading systems. Descriptive statistics were used to assess grade reclassifications. Mixed-effect multivariable logistic regression was used to measure the predictive ability of each grading system. The areas under the curves were compared.

RESULTS: Of the 322 injuries included, 27.0% were upgraded, 3.4% were downgraded, and 69.5% remained unchanged. Of the injuries graded as III or lower using the 1989 AAST, 33.5% were upgraded to grade IV using the 2018 AAST. Of the grade V injuries, 58.8% were downgraded using the 2018 AAST. There was no statistically significant difference in the overall areas under the curves between the 2018 and 1989 AAST grading system for predicting bleeding interventions (0.72 vs. 0.68, p = 0.34).

CONCLUSION: About one third of the injuries previously classified as grade III will be upgraded to grade IV using the 2018 AAST, which adds to the heterogeneity of grade IV injuries. Although the 2018 AAST grading provides more anatomic details on injury patterns and includes important radiologic findings, it did not outperform the 1989 AAST grading in predicting bleeding interventions.

LEVEL OF EVIDENCE: Prognostic and Epidemiological Study, level III.

Original languageEnglish (US)
Pages (from-to)357-365
Number of pages9
JournalJournal of Trauma and Acute Care Surgery
Issue number3
StatePublished - Mar 1 2020

Bibliographical note

Publisher Copyright:
Copyright © 2019 American Association for the Surgery of Trauma.)


  • Computed tomography
  • Multicenter study
  • Organ injury scale
  • Renal trauma
  • Trauma centers
  • Wounds and injuries
  • Kidney/diagnostic imaging
  • Humans
  • Male
  • Tomography, X-Ray Computed
  • Hemorrhage/diagnostic imaging
  • Injury Severity Score
  • Classification
  • Adult
  • Female

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Journal Article
  • Research Support, N.I.H., Extramural


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