01Approach to the Critical Patient/attcp54

Immediate priorities

›Hemodynamic threat assessment

›SBP < 90 mmHg or MAP < 65 mmHg

›Hemorrhagic shock from renal or associated injury

›Immediate IV access x2, large bore

›Tachycardia >100 bpm

›Serial vital signs every 15 minutes

›Fluid resuscitation 1-2 L IV crystalloid

›Expanding flank mass or abdominal distension

›Suggests retroperitoneal hemorrhage

›Trauma surgery activation

›Airway and breathing assessment

›Associated thoracic injury

›Rib fractures 10-12 with pneumothorax

›Hemothorax from combined thoracoabdominal injury

›Supplemental oxygen for SpO2 < 94%

›Target SpO2 94-98%

›Consider hemothorax if unilateral decreased breath sounds

›Gross hematuria triage

›Frank hematuria with hemodynamic instability

›Emergent CT abdomen/pelvis with contrast if stable enough

›Direct to OR without CT if unstable

›Gross hematuria with stable vitals

›CT imaging within 30-60 minutes

›AAST grading to guide management

Escalation triggers

›Indications for immediate trauma activation

›Hemodynamic instability not responding to 2 L IV fluids

02History/hx64

Mechanism and event details

›Mechanism of injury

›Blunt trauma types

›Direct flank blow

›Motor vehicle collision

›High-energy mechanisms raising concern for higher-grade injury

›Fall from height >3 metres

›Rapid deceleration (ureteropelvic junction disruption risk)

›Contact sports

›Football, rugby, MMA, skiing

›Lateral force vectors

›Injury timeline

›Time elapsed since injury

›Early vs delayed presentation

›Worsening or improving pain trajectory

›Pre-hospital interventions

›EMS scene vitals

›Fluids administered

Hematuria characterization

›Hematuria features

›Gross vs microscopic

›Pink-tinged vs frank red

›Clots present

›Duration and trend

›Persistent vs clearing

›Degree does not reliably predict injury grade

›Urinary symptoms

›Difficulty voiding

03Physical Exam/exam62

Vital signs and hemodynamic assessment

›Hemodynamic stability markers

›Blood pressure

›SBP < 90 mmHg triggers hemorrhagic shock protocol

›Serial readings every 15 minutes acutely

›Heart rate

›Tachycardia > 100 bpm as bleeding marker

›Relative bradycardia in vasovagal response

›Respiratory rate

›Increased rate with thoracic injury

›Pain-related splinting

›Lactate and perfusion indicators

›Capillary refill > 2 seconds

›Peripheral hypoperfusion marker

›Mental status changes

›Hemorrhagic shock neurological effect

›Class III-IV hemorrhage indicator

Flank and abdominal exam

›Flank findings

›Ecchymosis (Grey Turner sign)

›Retroperitoneal blood tracking

›May be delayed 24-48 hours

›Palpable mass

›Expanding perirenal hematoma

›Urinoma development

›Costovertebral angle tenderness

›Direct renal parenchymal injury

›Reproducible on percussion

04Differential Diagnosis/ddx51

Life-threatening diagnoses

›Higher-grade renal injuries

›AAST Grade III-V renal laceration

›ICD-10 S37.061 (major renal laceration)

›Collecting system involvement or vascular pedicle injury

›Renal pedicle avulsion or arterial thrombosis

›Absent nephrogram on contrast CT

›High-energy deceleration mechanism

›Ureteral injury

›Rare in blunt trauma < 1%

›Delayed contrast extravasation on CT urogram

›Associated solid organ injuries

›Splenic laceration

›Left-sided mechanism

›ICD-10 S36.031

›Hepatic laceration

›Right-sided mechanism

›ICD-10 S36.113

›Pancreatic injury

›Epigastric force vector

›Elevated lipase

Mimics and adjacent diagnoses

›Musculoskeletal injuries

›Lower rib fractures (ribs 10-12)

›ICD-10 S22.31-S22.39

›Normal urinalysis

›Lumbar transverse process fracture

›Posterior element tenderness

05Laboratory Tests/lt51

Urinalysis and hematuria evaluation

›Urinalysis

›Hematuria present in 88-94% of renal trauma

›Microhematuria defined as > 3 RBC/HPF

›Gross hematuria visible to naked eye

›Degree of hematuria does not reliably predict injury grade

›Vascular pedicle injuries may have minimal or no hematuria

›High-energy mechanism warrants CT regardless of UA

›Urine microscopy

›RBC casts

›Intrinsic renal disease consideration

›Glomerulonephritis differentiation

›Myoglobinuria screen

›Associated rhabdomyolysis in polytrauma

›Dipstick positive blood without RBCs on microscopy

Hematologic and coagulation studies

›Complete blood count

›Baseline hemoglobin/hematocrit

›Serial monitoring every 6 hours if gross hematuria

›Hemoglobin drop > 20 g/L suggests ongoing hemorrhage

›Platelet count

›Thrombocytopenia increases bleeding risk

›Target > 50 x10^9/L if active hemorrhage

›Coagulation studies

›PT/INR

›Warfarin anticoagulation quantification

›Target INR < 1.5 for hemostasis

›PTT

06Diagnostic Tests/dt101

Scoring Systems

›AAST Organ Injury Scale for kidney (2018 revision)

›Grade I: contusion or non-expanding subcapsular hematoma, no laceration

›Normal nephrogram on CT

›Management: non-operative, observation

›Grade II: perirenal hematoma confined to Gerota's fascia; laceration ≤ 1 cm depth, no urinary extravasation

›Perirenal hematoma contained within Gerota's fascia

›Management: non-operative in most cases

›Grade III: laceration > 1 cm depth without collecting system rupture or urinary extravasation

›Deep parenchymal injury

›Management: non-operative with close monitoring

›Grade IV: laceration involving collecting system with urinary extravasation; renal artery or vein injury with contained hemorrhage; segmental infarction

›ICD-10 S37.062 (major renal laceration with collecting system disruption)

›Management: angioembolization or surgical consideration

›Grade V: shattered kidney; avulsion of renal hilum with devascularization; laceration of segmental renal vein or artery with contained hematoma

›Highest mortality

›Management: operative in most cases

›AAST clinical significance

›Grade I-II: 75-98% of all renal injuries

›Heals without complications in vast majority

›Non-operative management standard of care

›2018 revision incorporated vascular injury into grading

›Improved correlation with management requirements

›Society of Interventional Radiology position statement supports endovascular intervention for Grade IV-V

MRI

›MRI indications in renal trauma

›Role is limited in acute trauma setting

›CT remains gold standard for acute evaluation

›MRI reserved for specific circumstances

›Indications for MRI over CT

›Contrast allergy where CT urogram contraindicated

›Radiation concern in pediatric or pregnant patients

›Characterization of equivocal renal lesion found on CT

›MRI findings in renal contusion

›Focal T2 hyperintensity in renal parenchyma

›Corresponds to edema and bruising

›No disruption of cortical outline

›No collecting system involvement

›Intact Gerota's fascia signal

›Absence of perirenal T2 bright fluid collections

›MRI limitations

›Not recommended for acute trauma triage

›Longer acquisition time

›Limited availability in emergency setting

›Motion artifact degrades image quality

›Requires cooperative patient

›Breath-hold sequences needed

CT

›CT abdomen/pelvis with IV contrast

›Gold standard for renal trauma evaluation

›Sensitivity > 98% for significant renal injury

›ACS Best Practices Guidelines support CT as primary modality

›Indications for CT in renal trauma

›Gross hematuria regardless of mechanism

›Microhematuria with hemodynamic instability (SBP < 90 mmHg)

›Additional CT indications

›High-energy mechanism (fall > 3 m, high-speed MVC)

›Flank ecchymosis or lower rib fractures

›Clinical suspicion despite absence of hematuria

›CT protocol for renal trauma

›Triple-phase imaging recommended

›Arterial phase: vascular injury and active extravasation

›Portal venous phase: parenchymal injury assessment

›Delayed urographic phase (10-15 minutes)

›Collecting system integrity assessment

›Contrast extravasation into retroperitoneum identifies UPJ or ureter disruption

›CT findings in renal contusion (Grade I)

›Focal or diffuse decreased parenchymal enhancement

›Bruising without laceration

›Small subcapsular hematoma possible

›No contrast extravasation

›Collecting system intact

›Gerota's fascia intact

›When CT may be omitted

›Microhematuria alone without hemodynamic instability

›Low-energy mechanism

›ACR Appropriateness Criteria supports selective CT in minor blunt trauma

›Shared decision-making with urology

›EAST Practice Management Guideline 2023 framework

›Intraoperative IVP

›Reserved for unstable patients taken to OR without CT

›Single-shot at 10 minutes post IV contrast bolus

›Confirms contralateral kidney function before nephrectomy

Ultrasound

›E-FAST examination

›Role in renal trauma triage

›Effective for detecting free intra-abdominal fluid

›Low sensitivity for renal parenchymal injury specifically

›Perinephric free fluid on E-FAST

›Raises suspicion for retroperitoneal hemorrhage

›Negative E-FAST does not exclude significant renal injury

›POCUS limitations in renal trauma

›Cannot reliably grade renal injury

›Cannot visualize collecting system integrity

›Cannot assess vascular pedicle

›Not recommended as primary diagnostic tool for renal trauma

›ACS guidelines and SIR position statement support CT over ultrasound

›WSES-AAST guidelines concur

›Ultrasound utility in follow-up

›Serial ultrasound for evolving perirenal hematoma

›Non-radiation follow-up option in stable patients

›Less accurate than CT for detailed characterization

›Urinoma monitoring

›Developing fluid collection post-injury

›Doppler assessment of renal perfusion

07Disposition/dispo57

Admission criteria

›Indications for hospital admission

›Gross hematuria (even AAST Grade I warrants short observation period)

›Minimum 24-hour observation

›Serial hemoglobin checks

›Hemodynamic instability or fluid responsiveness concern

›ICU or step-down level monitoring

›Continuous vital sign monitoring

›Anticoagulated patients with any degree of hematuria

›Higher bleeding risk requires admission observation

›Anticoagulation management consultation

›Additional admission indications

›Associated injuries requiring monitoring

›Rib fractures with respiratory compromise

›Other abdominal solid organ injuries

›Unreliable follow-up or social barriers

›Housing instability

›Unable to return for worsening symptoms

›Solitary kidney or bilateral injury

›Acute kidney injury risk monitoring

›Nephrology involvement

Discharge criteria

›Discharge eligibility for isolated renal contusion (Grade I)

›Hemodynamic stability throughout observation

›No orthostatic hypotension

›Stable serial hemoglobin

›Microscopic hematuria only (resolving or minimal) with no gross hematuria

›No clots on urinalysis

08Treatment/t80

Initial stabilization

›Resuscitation priorities

›IV access

›Two large-bore peripheral IVs (16-gauge or larger)

›IO access if IV access fails in unstable patient

›Fluid resuscitation for hemodynamic instability

›Isotonic crystalloid 1-2 L bolus IV

›Target MAP > 65 mmHg and urine output > 0.5 mL/kg/hour

›Massive transfusion protocol if hemorrhagic shock

›pRBC:FFP:platelets 1:1:1 ratio

›Tranexamic acid 1 g IV over 10 minutes if within 3 hours of injury

›Class I recommendation based on CRASH-2 trial evidence

›Second dose 1 g IV over 8 hours if ongoing hemorrhage

Non-operative management (standard of care for Grade I-II)

›Bed rest and activity restriction

›Initial bed rest until gross hematuria clears

›Gradual mobilization as tolerated

›Activity restriction until hematuria resolves

›Return to full activity

›Sports restriction 2-6 weeks minimum

›Urology clearance before contact sports

›Hydration

›IV fluids to maintain urine output

›Target > 0.5 mL/kg/hour to flush microscopic hematuria

›Transition to oral hydration when tolerated

›NPO if higher-grade injury concern or interventional procedure anticipated

›Maintain NPO for unstable patients pending CT

›Serial monitoring

›Urinalysis every 8-12 hours

›Hematuria trend assessment

›Gross to microscopic transition monitoring

›Serial hemoglobin

›Every 6 hours if gross hematuria present

›Threshold for transfusion: hemoglobin < 70 g/L or symptomatic anemia

Analgesia

›Analgesic ladder

›Acetaminophen (preferred first-line)

›650-1000 mg orally or IV every 6-8 hours

›Maximum 4000 mg per 24 hours (3000 mg if hepatic disease)

›Opioids for severe pain

›Morphine 2-4 mg IV every 4-6 hours PRN

›Titrate to pain relief

›Monitor respiratory depression

›Hydromorphone 0.2-0.4 mg IV every 3-4 hours PRN

›Preferred in renal impairment over morphine

›Active metabolite accumulation concern with morphine

›NSAIDs

›Generally avoided acutely due to renal effects and theoretical bleeding risk

›May be considered in recovery phase after hemostasis confirmed

Anticoagulation management

›Reversal in active hemorrhage

›Warfarin reversal

›Vitamin K 10 mg IV for urgent reversal (6-12 hour effect)

›4-factor PCC (Kcentra) 25-50 units/kg for immediate reversal

›Target INR < 1.5

›Dose based on presenting INR

›Direct oral anticoagulant reversal

›Dabigatran: idarucizumab (Praxbind) 5 g IV

›Anti-Xa agents (rivaroxaban, apixaban, edoxaban): andexanet alfa per weight-based protocol

›Low dose: 400 mg IV bolus then 480 mg IV over 2 hours

›High dose: 800 mg IV bolus then 960 mg IV over 2 hours

›Resume anticoagulation timing

›Individualized decision in consultation with prescribing team

›Minimum 48-72 hours held for active renal hemorrhage

Interventional and surgical management

›Angioembolization (Grade IV-V or persistent hemorrhage)

›Indications

›Hemodynamically stable with active contrast extravasation on CT

›Pseudoaneurysm or arteriovenous fistula identified

›Selective renal angioembolization

›Preserves maximum renal parenchyma

›SIR position statement supports endovascular intervention for trauma

›Success rates

›Technical success > 90% for appropriately selected cases

›Avoids nephrectomy in majority of cases

›Surgical intervention

›Absolute indications

›Hemodynamic instability with retroperitoneal hemorrhage not amenable to angioembolization

›Grade V injury with hilar avulsion

›Renal reconstruction (nephron-sparing)

›Preferred over nephrectomy when feasible

›Requires stable patient and operative expertise

›Nephrectomy

›Last resort for uncontrollable hemorrhage

›Confirm contralateral kidney function before nephrectomy (intraoperative IVP if no preoperative CT)

09Special Populations/sp82

Pregnancy

›Physiologic considerations in pregnancy

›Physiologic hydronephrosis of pregnancy

›Right > left due to uterine dextrorotation

›Increases vulnerability to collecting system injury

›Increased renal blood flow in pregnancy (up to 50% increase)

›Hematuria may be more prominent for equivalent injury grade

›Glomerular filtration rate elevated (baseline creatinine lower: 40-60 mmol/L normal in pregnancy)

›Imaging in pregnancy

›CT with IV contrast acceptable if benefit outweighs risk

›Use lowest effective radiation dose (ALARA principle)

›Fetal radiation exposure from single abdominal CT approximately 10-30 mGy (below teratogenic threshold of 100 mGy)

›MRI without gadolinium preferred alternative when time allows

›No ionizing radiation

›Gadolinium category C in pregnancy; avoid unless essential

›Ultrasound as initial screen

›E-FAST safe in pregnancy

›Limited renal injury characterization as in non-pregnant patients

›Management modifications

›Obstetric consultation mandatory for any trauma in pregnancy

›Fetal monitoring for minimum 4-6 hours after blunt abdominal trauma

›Placental abruption risk independent of abdominal impact

›Rh immunoglobulin (RhIG) for Rh-negative patients

›300 mcg IM within 72 hours of abdominal trauma

›Kleihauer-Betke test for quantification of fetomaternal hemorrhage

›Analgesic safety

›Acetaminophen safe in all trimesters

›NSAIDs contraindicated after 20 weeks (premature ductus closure)

›Opioids with caution (neonatal abstinence syndrome risk with prolonged use)

Geriatric

›Anatomic and physiologic changes

›Decreased perirenal fat padding

›Reduced protection against blunt force

›Lower-energy mechanisms can produce significant injury

›Reduced renal reserve

›Lower baseline GFR (estimated GFR often 45-60 mL/min in elderly)

›Contrast nephropathy risk increased

›Polypharmacy and anticoagulation

›Higher prevalence of anticoagulant and antiplatelet use

›Warfarin, DOACs, aspirin interactions increase hemorrhagic risk

›Diagnostic considerations

›Higher threshold for CT in elderly due to atrial fibrillation fall mechanisms

›Anticoagulation on board lowers threshold for imaging

›Even minor mechanisms warrant CT if on anticoagulants

›Baseline creatinine important for comparison

›Acute kidney injury superimposed on chronic kidney disease

›Contrast dosage and hydration planning

›Management modifications

›Fluid resuscitation caution

›Risk of pulmonary edema with aggressive IV fluids

›Titrated resuscitation with early invasive monitoring if needed

›Analgesic modifications

›Opioid dose reduction (25-50% of standard adult dose)

›Avoid NSAIDs in elderly due to GI and renal effects

›Anticoagulation reversal

›More likely to require reversal given higher prevalence of use

›Increased risk of intracranial hemorrhage with concurrent head injury

Pediatrics

›Anatomic vulnerability

›Less perirenal fat providing cushioning

›Proportionally larger kidneys relative to body size

›Thinner and less-developed abdominal musculature

›Incomplete rib ossification (ribs more pliable)

›Less rib cage protection for retroperitoneal structures

›Significant renal injury can occur without rib fractures

›Higher rates of renal anomalies (horseshoe kidney, UPJ obstruction, hydronephrosis)

›Pre-existing anomalies increase injury severity for given mechanism

›Imaging considerations

›CT with contrast remains gold standard but radiation concern

›Use pediatric dose-reduction protocols (ALARA)

›MRI alternative if available and patient stable

›FAST less sensitive than in adults for retroperitoneal injury

›CT preferred if clinical suspicion high

›Microhematuria thresholds same as adults (> 3 RBC/HPF)

›Degree of hematuria does not predict injury severity in children

›Management modifications

›Non-operative management strongly preferred in children

›Even higher-grade injuries (Grade III-IV) managed non-operatively when hemodynamically stable

›Angioembolization before nephrectomy in appropriate centers

›Weight-based analgesic dosing

›Acetaminophen 15 mg/kg orally every 6 hours (max 75 mg/kg/day)

›Morphine 0.05-0.1 mg/kg IV every 4 hours PRN (max 4 mg/dose)

›Fluid resuscitation

›Isotonic crystalloid 20 mL/kg IV bolus

›Reassess after each bolus; avoid over-resuscitation

10Background/b83

Epidemiology

›Incidence and distribution

›Renal injuries occur in 1-5% of all trauma cases

›Kidney is the most commonly injured genitourinary organ

›Blunt trauma accounts for 80-95% of renal injuries

›AAST Grade distribution

›Grade I-II: 75-98% of all renal injuries

›Grade III-V: 5-25% of renal injuries

›Mortality

›Isolated renal contusion (Grade I): mortality approaches 0%

›Renal injury mortality correlates with associated injuries, not renal grade alone

›Demographics and mechanisms

›Male predominance (approximately 3:1 male to female ratio)

›Higher participation in high-risk activities

›Combat sports and contact sports

›Peak incidence in 2nd-4th decade

›Motor vehicle collisions dominant cause

›Sports injuries in younger populations

›Pediatric vulnerability

›Children overrepresented relative to adults for given mechanism energy

›Incomplete rib cage protection and larger relative kidney size

›Associated injuries

›Concurrent intra-abdominal injuries in 44% of renal trauma cases

›Spleen most commonly associated organ

›Liver in right-sided mechanisms

›Rib fractures (ribs 10-12) in 10-20% of renal injuries

›Lumbar transverse process fractures concurrent

›Thoracic aortic injury in high-energy deceleration

Pathophysiology

›Mechanism of renal contusion

›Direct compressive force to renal parenchyma

›Bruising without architectural disruption

›Microvascular injury with parenchymal edema

›Energy transmission pathways

›Posterior forces through lower rib cage and paravertebral musculature

›Anterior forces through abdominal wall and perinephric fat

›Hematuria mechanism

›Disruption of glomerular and peritubular capillaries

›RBCs enter tubular lumen

›Excreted in urine as microscopic or gross hematuria

›Hematuria severity-injury grade discordance

›Vascular pedicle injuries (Grade V) may present with minimal hematuria

›Grade I injuries can have gross hematuria due to calyceal proximity

›Healing and natural history

›Grade I contusions heal spontaneously within 1-2 weeks

›Microscopic hematuria may persist for days to weeks

›No structural renal damage expected

›Rare complications from Grade I injury

›Delayed hemorrhage from pseudoaneurysm exceedingly uncommon

›Up to 25% of moderate-severe injuries develop pseudoaneurysm or AV fistula; far less common in Grade I

›Post-traumatic hypertension pathophysiology

›Page kidney phenomenon

›Subcapsular hematoma compresses renal parenchyma

›Activates renin-angiotensin-aldosterone system

›Renal artery injury with renovascular hypertension

›Goldblatt mechanism (renal ischemia driving HTN)

›Reported incidence of post-traumatic hypertension 0-6.6%

Therapeutic Considerations

›Non-operative management rationale

›Standard of care for Grade I-II injuries (Class I recommendation)

›EAST Practice Management Guidelines 2023 support expectant management

›WSES-AAST Guidelines 2019 concordant

›Complication rates for Grade I extremely low

›Less than 1% require intervention after initial non-operative management

›Routine follow-up CT does not change management for Grade I-II (Kelly et al., Injury 2022)

›Angioembolization evidence base

›SIR position statement on endovascular intervention for trauma (2020)

›Supports selective renal angioembolization for hemostasis

›Preferred over operative management when feasible and patient stable

›Nephron preservation advantage

›Preserves more renal parenchyma than nephrectomy

›Reduces long-term renal dysfunction risk

›Anticoagulation considerations

›Even low-grade injuries carry higher hemorrhage risk on anticoagulants

›Individualized reversal decision based on thrombotic vs hemorrhagic risk

›Multidisciplinary approach with prescribing team

›Resumption timing

›No standardized guidelines for anticoagulation resumption post-renal trauma

›Generally 48-72 hours minimum if active hemorrhage resolved

›Activity restriction evidence

›Return to sports after resolution of hematuria

›Typical timeline 2-6 weeks for Grade I-II injuries

›No randomized controlled trial data; expert consensus guidance

›Contact sport risk of repeat injury

›Single kidney significantly increases stakes of subsequent injury

›Protective equipment (flak vest, kidney belt) consideration for high-risk sports

11Patient Discharge Instructions/pdi44

copy discharge instructions

›You were diagnosed with a renal contusion (kidney bruise)

›This is a Grade I kidney injury, meaning a bruise without a tear or major damage

›Most kidney contusions heal completely within 1-2 weeks without surgery

›Activity restrictions

›Rest and limit strenuous activity for at least 1-2 weeks

›No heavy lifting, running, or vigorous exercise until cleared by your doctor

›No contact sports (football, hockey, martial arts, skiing) until your urology follow-up

›Gradually increase activity as pain improves

›Walking is acceptable if comfortable

›Stop any activity that worsens pain or causes blood in urine

›Medications at home

›Take acetaminophen (Tylenol) 500-1000 mg every 6-8 hours as needed for pain

›Do not exceed 4000 mg in 24 hours

›Avoid ibuprofen (Advil, Motrin) or naproxen (Aleve) unless specifically instructed by your doctor

›If prescribed pain medication, take as directed

›Do not drive or operate machinery while taking opioid pain medication

›Hydration

›Drink plenty of fluids (6-8 glasses of water daily)

›Adequate hydration helps flush blood from the urine

›Avoid alcohol during recovery

›Expected recovery

›Blood in your urine (pink or red colour) may persist for several days

›It should gradually clear to normal yellow within 1-2 weeks

›Mild flank or side pain is expected during healing

›Blood pressure should be monitored at follow-up

›Rare cases of high blood pressure can develop after kidney injury

›Follow-up appointment

12References/r39

Guidelines and key sources

›EAST Practice Management Guidelines: Management of Adult Renal Trauma

›Aziz HA, Bugaev N, Baltazar G, et al. BMC Surgery 2023

›Systematic review supporting non-operative management for Grade I-IV renal injuries

›EAST GRADE methodology

›WSES-AAST Guidelines on Kidney and Uro-Trauma

›Coccolini F, Moore EE, Kluger Y, et al. World Journal of Emergency Surgery 2019

›International consensus on non-operative management

›Angioembolization role for hemostasis

›ACS Best Practices Guidelines: Management of Genitourinary Injuries

›Johnsen N, Wessells H, Archer-Arroyo K, et al. American College of Surgeons 2025

›CT as gold standard imaging modality

›Operative and non-operative decision thresholds

Imaging guidelines

›ACR Appropriateness Criteria: Minor Blunt Trauma

›Expert Panel on Polytrauma Imaging, Hoff CN, Hajibonabi F, et al. JACR 2026

›Selective CT use in minor blunt trauma

›Radiation risk-benefit framework

›ACS Best Practices Guidelines in Imaging

›Tominaga GT, Bernstein M, Aquino MR, et al. American College of Surgeons 2018

›CT protocol recommendations for abdominal trauma

›Triple-phase imaging for renal injury

AAST grading and classification

›AAST Organ Injury Scale for Kidney (2018 Revision)

›Dixe de Oliveira Santo I, Sailer A, Solomon N, et al. Radiographics 2023

›Updated grading incorporating vascular injury

›Clinical implications of revised classification

›Hosein M, Paskar D, Kodama R, Ditkofsky N. AJR 2019

Evidence & Review