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Matta R, Keihani S, Hebert K, Horns JJ, Nirula R, McCrum M, McCormick BJ, Gross JA, Joyce RP, Rogers DM, Wang SS, Hagedorn JC, Selph JP, Sensenig RL, Moses RA, Dodgion CM, Gupta S, Mukherjee K, Majercik S, Broghammer JA, Schwartz I, Elliott SP, Breyer BN, Baradaran N, Zakaluzny S, Erickson BA, Miller BD, Askari R, Carrick MM, Burks FN, Norwood S, Myers JB. PROPOSED REVISION OF THE AMERICAN ASSOCIATION FOR SURGERY OF TRAUMA RENAL TRAUMA ORGAN INJURY SCALE: SECONDARY ANALYSIS OF THE MULTI-INSTITUTIONAL GENITOURINARY TRAUMA STUDY. J Trauma Acute Care Surg 2024:01586154-990000000-00628. [PMID: 38319246 DOI: 10.1097/ta.0000000000004232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND This study updates the American Association for Surgery of Trauma (AAST) Organ Injury Scale (OIS) for renal trauma using evidence-based criteria for bleeding control intervention. METHODS This was a secondary analysis of a multi-center retrospective study including patients with high grade renal trauma from 7 Level-1 trauma centers from 2013-2018. All eligible patients were assigned new renal trauma grades based on revised criteria. The primary outcome used to measure injury severity was intervention for renal bleeding. Secondary outcomes included intervention for urinary extravasation, units of packed red blood cells (PRBCs) transfused within 24 hours, and mortality. To test the revised grading system, we performed mixed effect logistic regression adjusted for multiple baseline demographic and trauma covariates. We determined the area under the receiver-operator curve (AUC) to assess accuracy of predicting bleeding interventions from the revised grading system and compared this to 2018 AAST organ injury scale. RESULTS based on the 2018 OIS grading system, we included 549 patients with AAST Grade III-V injuries and CT scans (III: 52% (n = 284), IV: 45% (n = 249), and V: 3% (n = 16)). Among these patients, 89% experienced blunt injury (n = 491) and 12% (n = 64) underwent intervention for bleeding. After applying the revised grading criteria, 60% (n = 329) of patients were downgraded and 4% (n = 23) were upgraded; 2.8% (n = 7) downgraded from grade V to IV, and 69.5% (n = 173) downgraded from IV to III. The revised renal trauma grading system demonstrated improved predictive ability for bleeding interventions (2018 AUC = 0.805, revised AUC = 0.883; p = 0.001) and number of units of PRBCs transfused. When we removed urinary injury from the revised system, there was no difference in its predictive ability for renal hemorrhage intervention. CONCLUSIONS A revised renal trauma grading system better delineates the need for hemostatic interventions than the current AAST OIS renal trauma grading system. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Rano Matta
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Sorena Keihani
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Kevin Hebert
- Department of Surgery, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Joshua J Horns
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Raminder Nirula
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Marta McCrum
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | | | - Joel A Gross
- Department of Radiology, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Ryan P Joyce
- NYU Grossman School of Medicine, New York, NY, USA
| | - Douglas M Rogers
- Department of Radiology, University of Utah Salt Lake City, UT, USA
| | | | - Judith C Hagedorn
- Department of Urology, Harborview Medical Center, University of Washington, Seattle, Washington
| | - J Patrick Selph
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rachel L Sensenig
- Division of Trauma, Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Rachel A Moses
- Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Shubham Gupta
- Department of Urology, Case Western Reserve University, Cleveland, OH, USA
| | - Kaushik Mukherjee
- Division of Acute Care Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Sarah Majercik
- Division of Trauma and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA
| | | | - Ian Schwartz
- Department of Urology, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Benjamin N Breyer
- Department of Urology, University of California - San Francisco, San Francisco, CA, USA
| | - Nima Baradaran
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Scott Zakaluzny
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | | | - Brandi D Miller
- Department of Urology, Detroit Medical Center, Detroit, MI, USA
| | - Reza Askari
- Division of Trauma, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Frank N Burks
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Scott Norwood
- Department of Surgery, UT Health Tyler, Tyler, TX, USA
| | - Jeremy B Myers
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
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Keihani S, Rogers DM, Wang SS, Gross JA, Joyce RP, Hagedorn JC, Majercik S, Sensenig RL, Schwartz I, Erickson BA, Moses RA, Selph JP, Norwood S, Smith BP, Dodgion CM, Mukherjee K, Breyer BN, Baradaran N, Myers JB. Shattered Kidney After Renal Trauma: Should It Be Classified As an American Association for the Surgery of Trauma Grade V Injury? Urology 2023; 179:181-187. [PMID: 37356461 DOI: 10.1016/j.urology.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To study the prevalence and management of shattered kidney and to evaluate if the new description of "loss of identifiable renal anatomy" in the 2018 American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) would improve the ability to predict bleeding control interventions. METHODS We used high-grade renal trauma data from 21 Level-1 trauma centers from 2013 to 2018. Initial CT scans were reviewed to identify shattered kidneys, defined as a kidney having ≥3 parenchymal fragments displaced by blood or fluid on cross-sectional imaging. We further categorized patients with shattered kidney in two models based on loss of identifiable renal parenchymal anatomy and presence or absence of vascular contrast extravasation (VCE). Bleeding interventions were compared between the groups. RESULTS From 861 high-grade renal trauma patients, 41 (4.8%) had shattered kidney injury. 25 (61%) underwent a bleeding control intervention including 18 (43.9%) nephrectomies and 11 (26.8%) angioembolizations. 18 (41%) had shattered kidney with "loss of identifiable parenchymal renal anatomy" per 2018 AAST OIS (model-1). 28 (68.3%) had concurrent VCE (model-2). Model-2 had a statistically significant improvement in area under the curve over model-1 in predicting bleeding interventions (0.75 vs 0.72; P = .01). CONCLUSION Shattered kidney is associated with high rates of active bleeding, urinary extravasation, and interventions including nephrectomy. The definition of shattered kidney is vague and subjective and our definition might be simpler and more reproducible. Loss of identifiable renal anatomy per the 2018 AAST OIS did not provide better distinction for bleeding control interventions over presence of VCE.
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Affiliation(s)
- Sorena Keihani
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT.
| | | | | | - Joel A Gross
- Department of Radiology, University of Washington, Seattle, WA
| | - Ryan P Joyce
- Department of Radiology, University of Washington, Seattle, WA
| | | | - Sarah Majercik
- Division of Trauma and Surgical Critical Care, Intermountain Medical Center, Murray, UT
| | - Rachel L Sensenig
- Division of Trauma, Department of Surgery, Cooper University Hospital, Camden, NJ
| | - Ian Schwartz
- Department of Urology, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
| | | | - Rachel A Moses
- Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | | | | | - Brian P Smith
- Division of Trauma and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | - Kaushik Mukherjee
- Division of Acute Care Surgery, Loma Linda University Medical Center, Loma Linda, CA
| | - Benjamin N Breyer
- Department of Urology, University of California - San Francisco, San Francisco, CA
| | - Nima Baradaran
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
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Hakam N, Keihani S, Shaw NM, Abbasi B, Jones CP, Rogers D, Wang SS, Gross JA, Joyce RP, Hagedorn JC, Selph JP, Sensenig RL, Moses RA, Dodgion CM, Gupta S, Mukherjee K, Majercik S, Smith BP, Broghammer JA, Schwartz I, Baradaran N, Zakaluzny SA, Erickson BA, Miller BD, Askari R, Carrick MM, Burks FN, Norwood S, Myers JB, Breyer BN. Grade V renal trauma management: results from the multi-institutional genito-urinary trauma study. World J Urol 2023; 41:1983-1989. [PMID: 37356027 DOI: 10.1007/s00345-023-04432-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/09/2023] [Indexed: 06/27/2023] Open
Abstract
PURPOSE To investigate management trends for American Association for the Surgery of Trauma (AAST) grade V renal trauma with focus on non-operative management. METHODS We used prospectively collected data as part of the Multi-institutional Genito-Urinary Trauma Study (MiGUTS). We included patients with grade V renal trauma according to the AAST Injury Scoring Scale 2018 update. All cases submitted by participating centers with radiology images available were independently reviewed to confirm renal trauma grade. Management was classified as expectant, conservative (minimally invasive, endoscopic or percutaneous procedures), or operative (renal-related surgery). RESULTS Eighty patients were included, 25 of whom had complete imaging and had independent confirmation of AAST grade V renal trauma. Median age was 35 years (Interquartile range (IQR) 25-50) and 23 (92%) had blunt trauma. Ten patients (40%) were managed operatively with nephrectomy. Conservative management was used in nine patients (36%) of which six received angioembolization and three had a stent or drainage tube placed. Expectant management was followed in six (24%) patients. Transfusion requirements were progressively higher with groups requiring more aggressive treatment, and injury characteristics differed significantly across management groups in terms of hematoma size and laceration size. Vascular contrast extravasation was more likely in operatively managed patients though a statistically significant association was not found. CONCLUSION Successful use of nonoperative management for grade V injuries is used for a substantial subset of patients. Lower transfusion requirement and less severe injury radiologic phenotype appear to be important characteristics delineating this group.
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Affiliation(s)
- Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Sorena Keihani
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Nathan M Shaw
- Department of Urology, Medstar Georgetown University Hospital, Washington, DC, USA
- Department of Plastic and Reconstructive Surgery, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Behzad Abbasi
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Charles P Jones
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Douglas Rogers
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Sherry S Wang
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Joel A Gross
- Department of Radiology, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Ryan P Joyce
- Department of Radiology, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Judith C Hagedorn
- Department of Urology, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - J Patrick Selph
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rachel L Sensenig
- Division of Trauma, Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Rachel A Moses
- Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Shubham Gupta
- Department of Urology, University of Kentucky, Lexington, KY, USA
| | - Kaushik Mukherjee
- Division of Acute Care Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Sarah Majercik
- Division of Trauma and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA
| | - Brian P Smith
- Division of Trauma and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Ian Schwartz
- Department of Urology, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - Nima Baradaran
- Department of Urology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Scott A Zakaluzny
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | | | - Brandi D Miller
- Department of Urology, Detroit Medical Center, Detroit, MI, USA
| | - Reza Askari
- Division of Trauma, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Frank N Burks
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Scott Norwood
- Department of Surgery, UT Health Tyler, Tyler, TX, USA
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA, USA.
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
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Keihani S, Wang SS, Joyce RP, Rogers DM, Gross JA, Nocera AP, Selph JP, Fang E, Hagedorn JC, Voelzke BB, Rezaee ME, Moses RA, Arya CS, Sensenig RL, Glavin K, Broghammer JA, Higgins MM, Gupta S, Becerra CMC, Baradaran N, Zhang C, Presson AP, Nirula R, Myers JB. External validation of a nomogram predicting risk of bleeding control interventions after high-grade renal trauma: The Multi-institutional Genito-Urinary Trauma Study. J Trauma Acute Care Surg 2021; 90:249-256. [PMID: 33075030 PMCID: PMC8717860 DOI: 10.1097/ta.0000000000002987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Renal trauma grading has a limited ability to distinguish patients who will need intervention after high-grade renal trauma (HGRT). A nomogram incorporating both clinical and radiologic factors has been previously developed to predict bleeding control interventions after HGRT. We aimed to externally validate this nomogram using multicenter data from level 1 trauma centers. METHODS We gathered data from seven level 1 trauma centers. Patients with available initial computed tomography (CT) scans were included. Each CT scan was reviewed by two radiologists blinded to the intervention data. Nomogram variables included trauma mechanism, hypotension/shock, concomitant injuries, vascular contrast extravasation (VCE), pararenal hematoma extension, and hematoma rim distance (HRD). Mixed-effect logistic regression was used to assess the associations between the predictors and bleeding intervention. The prediction accuracy of the nomogram was assessed using the area under the receiver operating characteristic curve and its 95% confidence interval (CI). RESULTS Overall, 569 HGRT patients were included for external validation. Injury mechanism was blunt in 89%. Using initial CT scans, 14% had VCE and median HRD was 1.7 (0.9-2.6) cm. Overall, 12% underwent bleeding control interventions including 34 angioembolizations and 24 nephrectomies. In the multivariable analysis, presence of VCE was associated with a threefold increase in the odds of bleeding interventions (odds ratio, 3.06; 95% CI, 1.44-6.50). Every centimeter increase in HRD was associated with 66% increase in odds of bleeding interventions. External validation of the model provided excellent discrimination in predicting bleeding interventions with an area under the curve of 0.88 (95% CI, 0.84-0.92). CONCLUSION Our results reinforce the importance of radiologic findings such as VCE and hematoma characteristics in predicting bleeding control interventions after renal trauma. The prediction accuracy of the proposed nomogram remains high using external data. These variables can help to better risk stratify high-grade renal injuries. LEVEL OF EVIDENCE Prognostic and epidemiological study, level III.
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Affiliation(s)
- Sorena Keihani
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Sherry S. Wang
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Ryan P. Joyce
- Department of Radiology, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Douglas M. Rogers
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Joel A. Gross
- Department of Radiology, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Alexander P. Nocera
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J. Patrick Selph
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elisa Fang
- Department of Urology, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Judith C. Hagedorn
- Department of Urology, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | | | - Michael E. Rezaee
- Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Rachel A. Moses
- Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Chirag S. Arya
- Division of Trauma, Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Rachel L. Sensenig
- Division of Trauma, Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Katie Glavin
- University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | - Shubham Gupta
- Department of Urology, Case Western Reserve University, Cleveland, OH, USA
| | | | - Nima Baradaran
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Chong Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Angela P. Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Raminder Nirula
- Division of General Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jeremy B. Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
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5
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Armas-Phan M, Keihani S, Agochukwu-Mmonu N, Cohen AJ, Rogers DM, Wang SS, Gross JA, Joyce RP, Hagedorn JC, Voelzke B, Moses RA, Sensenig RL, Selph JP, Gupta S, Baradaran N, Erickson BA, Schwartz I, Elliott SP, Mukherjee K, Smith BP, Santucci RA, Burks FN, Dodgion CM, Carrick MM, Askari R, Majercik S, Nirula R, Myers JB, Breyer BN. Clinical and Radiographic Factors Associated With Failed Renal Angioembolization: Results From the Multi-institutional Genitourinary Trauma Study (Mi-GUTS). Urology 2020; 148:287-291. [PMID: 33129870 DOI: 10.1016/j.urology.2020.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To find clinical or radiographic factors that are associated with angioembolization failure after high-grade renal trauma. MATERIAL AND METHODS Patients were selected from the Multi-institutional Genito-Urinary Trauma Study. Included were patients who initially received renal angioembolization after high-grade renal trauma (AAST grades III-V). This cohort was dichotomized into successful or failed angioembolization. Angioembolization was considered a failure if angioembolization was followed by repeat angiography and/or an exploratory laparotomy. RESULTS A total of 67 patients underwent management initially with angioembolization, with failure in 18 (27%) patients. Those with failed angioembolization had a larger proportion ofgrade IV (72% vs 53%) and grade V (22% vs 12%) renal injuries. A total of 53 patients underwent renal angioembolization and had initial radiographic data for review, with failure in 13 cases. The failed renal angioembolization group had larger perirenal hematoma sizes on the initial trauma scan. CONCLUSION Angioembolization after high-grade renal trauma failed in 27% of patients. Failed angioembolization was associated with higher injury grade and a larger perirenal hematoma. Likely these characteristics are associated with high-grade renal trauma that may be less amenable to successful treatment after a single renal angioembolization.
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Affiliation(s)
- Manuel Armas-Phan
- School of Medicine, University of California-San Francisco, San Francisco, CA; Department of Urology, Emory University, Atlanta, GA
| | - Sorena Keihani
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | | | - Andrew J Cohen
- Department of Urology, University of California-San Francisco, San Francisco, CA; Department of Urology, James Buchanan Brady Urological Institute, Baltimore, MD
| | | | - Sherry S Wang
- Department of Radiology, University of Utah, Salt Lake City, UT
| | - Joel A Gross
- Department of Radiology, Harborview Medical Center, University of Washington, Seattle, WA
| | - Ryan P Joyce
- Department of Radiology, Harborview Medical Center, University of Washington, Seattle, WA
| | - Judith C Hagedorn
- Department of Urology, Harborview Medical Center, University of Washington, Seattle, WA
| | | | - Rachel A Moses
- Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Rachel L Sensenig
- Department of Surgery, Division of Trauma, Cooper University Hospital, Camden, NJ
| | - J Patrick Selph
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL
| | - Shubham Gupta
- Department of Urology, Case Western Reserve University, Cleveland, OH
| | - Nima Baradaran
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Ian Schwartz
- Department of Urology, University of Minnesota, Minneapolis, MN
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN
| | - Kaushik Mukherjee
- Division of Acute Care Surgery, Loma Linda University Medical Center, Loma Linda, CA
| | - Brian P Smith
- Division of Trauma and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | - Frank N Burks
- Department of Urology, Oakland University William Beaumont School of Medicine, Auburn Hills, MI
| | | | | | - Reza Askari
- Department of Surgery, Division of Trauma, Brigham and Women's Hospital, Boston, MA
| | - Sarah Majercik
- Division of Trauma and Surgical Critical Care, Intermountain Medical Center, Salt Lake City, UT
| | - Raminder Nirula
- Department of Surgery, University of Utah, Salt Lake City, UT
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, CA; Department of Biostatistics and Epidemiology, University of California-San Francisco, San Francisco, CA.
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