03 August 2021>: Articles
Unusual clinical course, Challenging differential diagnosis, Management of emergency careJohn D. Ehrhardt A , Adel Elkbuli A* , Mark McKenney A , Dessy Boneva A
Am J Case Rep 2021; 22:e932357
Table 1. AAST Revised 2018 Renal Injury Grading Scale .
|I||Subcapsular hematoma/renal parenchymal contusion without laceration||Observation, no restrictions in absence of other injuries|
|II||Hematoma confined to Gerota’s fascia; laceration||Observation, bedrest, hemoglobin/hematocrit trending|
|III||Laceration >1 cm with no collecting duct injury; any urinary or vascular extravasation||Resuscitation, angioembolization, H&H trending, hemodynamic monitoring|
|IV||Laceration of collecting system; ureteropelvic transection; hemorrhage beyond Gerota’s fascia; segmental vessel bleeding/thrombosis||Resuscitation, angioembolization vs operative management; above measures; likely repeat CT imaging|
|V||Shattered kidney with destroyed parenchyma; main renal vessel avulsion; devascularized kidney with active bleeding||Similar to grade IV management, controversial and based on patient stability and response to resuscitation|
|AAST– American Association for the Surgery of Trauma; CT – computed tomography; H&H – hematocrit and hemoglobin.|
* Current evidence on follow-up imaging is evolving literature.