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.