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AAST Revises Renal Injury Grading

Organ injury scaling was developed to give clinicians and researchers a common language for describing and studying the effects of trauma. The Organ Injury Scaling classification for kidney injuries was developed by the AAST in 1989. Over time, it was recognized that grades IV and V were somewhat confusing, and some injuries were not originally included. An updated grading system was published this month to correct these shortcomings.

Grades I, II, and III remain unchanged. Grades IV and V are updated as follows:

  • Grade IV – originally encompassed contained injuries to the main renal artery and vein, and collecting system injuries. Revision: adds segmental arterial and venous injury, and laceration to the renal pelvis or ureteropelvic junction. Multiple lacerations into the collecting system used to be considered a shattered kidney (Grade V), but now remains Grade IV.
  • Grade V – orignally included main renal artery or vein laceration or avulsion, and multiple collecting system lacerations (shattered kidney). The revised classification includes only vascular injury (arterial or venous) and includes laceration, avulsion or thrombosis.

Reference: Revision of current American Association for the Surgery of Trauma renal injury grading system. J Trauma 70(1):35-37, 2011.

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Nail Discoloration After Severe Traumatic Brain Injury (TBI)

Occasionally, patients who have had a severe brain injury but recovered relatively quickly may present with complaints of odd nail discoloration. This may involve fingernails and/or toenails. What gives?

This is actually a byproduct of repeated exams to determine the Glasgow Coma Scale score. A common way to determine the motor component is to squeeze the fingertip or toetip. I’ve seen some neurosurgeons use a pen to apply a great deal of force to the nail.

The discoloration is a resolving subungual hematoma. You may see different colors under different nails, depending on the age of the hematoma. Amaze your colleagues with your knowledge on this one!

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Trauma Is The Leading Cause of Death …

We read this phrase all the time, in the newspapers and in many journal articles relating to trauma. Where do they get this? Well, it comes from mortality statistics compiled by the Center for Disease Control.

Trauma IS the leading cause of death in ages 1-44. In infants, congenital defects cause the most deaths and trauma is only #4. At age 45 and above, it begins to drop off, but stays in the top 5 until age 65 when it drops to #9. Overall, trauma is the #5 killer for all age groups combined.

This image shows the top 5 causes of death across all age groups. The blue boxes are unintentional trauma, the red boxes are homicide, and the green boxes are suicide.

One fact that tends to surprise people is that suicide is such a common cause of death. Suicides are not typically reported in the news, so most people are unaware unless it involves their family or friends.

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