World journal of urology · 2025
External validation of the MiGUTS nomogram following predominantly penetrating renal trauma in a South African population.
СтатьяВалидационное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Reinisch Julian, de Klerk Cecelia, Maasdorp Elizna, Kotzé Pieter, Mashavane Claire, Herrmann Thomas R W, Eberli Daniel, van der Merwe André, Strebel Räto T
Аннотация
INTRODUCTION: The management of high-grade renal trauma (HGRT) is challenged by the limitations of the American Association for the Surgery of Trauma (AAST) renal trauma grading system. To enhance predictive accuracy for bleeding control interventions, Keihani et al. introduced the Multi-Institutional Genito-Urinary Trauma Study (MiGUTS) in 2019. This study aims to externally validate the MiGUTS nomogram using a South African Level 1 trauma center cohort with a unique penetrating predominant population.
METHODS: Data were collected retrospectively from June 2021 to December 2023 at Tygerberg Hospital, encompassing all patients aged ≥ 18 years with AAST ≥ 3 renal trauma who underwent abdominal computed tomography imaging. Two blinded radiologists reviewed each scan. The nomogram incorporated trauma mechanism, hypotension/shock, concomitant injuries, vascular contrast extravasation (VCE), pararenal hematoma extension, and hematoma rim distance (HRD). Predictive accuracy was evaluated using the area under the receiver operating characteristic curve (AUC) and its 95% confidence interval (CI).
RESULTS: A total of 129 patients were included; 74% had penetrating trauma, and the median age was 30 years. Bleeding intervention was required in 12% (6 nephrectomies, 9 angioembolizations). Using the MiGUTS nomogram we obtained an AUC of 0.80, with a sensitivity of 0.73, specificity of 0.64, positive predictive value of 0.21, and negative predictive value of 0.95.
CONCLUSION: While the MiGUTS nomogram demonstrated high discriminatory power in our cohort, our AUC of 0.80 fell outside the 95% confidence interval reported by Keihani et al. Differences in trauma mechanisms, particularly the high rate (74%) of penetrating injuries, suggest a need for an adjusted nomogram for penetrating renal trauma.
METHODS: Data were collected retrospectively from June 2021 to December 2023 at Tygerberg Hospital, encompassing all patients aged ≥ 18 years with AAST ≥ 3 renal trauma who underwent abdominal computed tomography imaging. Two blinded radiologists reviewed each scan. The nomogram incorporated trauma mechanism, hypotension/shock, concomitant injuries, vascular contrast extravasation (VCE), pararenal hematoma extension, and hematoma rim distance (HRD). Predictive accuracy was evaluated using the area under the receiver operating characteristic curve (AUC) and its 95% confidence interval (CI).
RESULTS: A total of 129 patients were included; 74% had penetrating trauma, and the median age was 30 years. Bleeding intervention was required in 12% (6 nephrectomies, 9 angioembolizations). Using the MiGUTS nomogram we obtained an AUC of 0.80, with a sensitivity of 0.73, specificity of 0.64, positive predictive value of 0.21, and negative predictive value of 0.95.
CONCLUSION: While the MiGUTS nomogram demonstrated high discriminatory power in our cohort, our AUC of 0.80 fell outside the 95% confidence interval reported by Keihani et al. Differences in trauma mechanisms, particularly the high rate (74%) of penetrating injuries, suggest a need for an adjusted nomogram for penetrating renal trauma.