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Development and Validation of a Renal Replacement after Trauma Scoring Tool
Jeffrey Santos1, Areg Grigorian1, Catherine Kuza2
1From the Division of Trauma, Burns, & Surgical Critical Care, University of California, Irvine, Orange, CA (Santos, Grigorian, Jeng, Qazi).
Journal of the American College of Surgeons
|February 27, 2023
Summary
A new Renal Replacement after Trauma (RAT) score helps predict which trauma patients need renal replacement therapy (RRT). This tool aids resource allocation during healthcare system stress, validated with high accuracy.
Area of Science:
- Trauma care
- Nephrology
- Healthcare resource management
Background:
- Healthcare systems face resource allocation challenges, particularly for renal replacement therapy (RRT).
- The COVID-19 pandemic highlighted difficulties in accessing RRT for trauma patients.
- A predictive tool is needed to identify trauma patients requiring RRT.
Purpose of the Study:
- To develop and validate a scoring tool, Renal Replacement after Trauma (RAT), to predict RRT needs in trauma patients.
- To aid in the allocation of RRT resources during hospitalization.
- To improve preparedness for resource limitations.
Main Methods:
- Utilized the 2017-2020 TQIP database, split into derivation and validation sets.
- Included adult trauma patients admitted from ED to OR or ICU, excluding those with CKD or transfers.
- Developed a scoring tool using logistic regression and validated with AUROC.
Main Results:
- The RAT score, derived from 11 predictors, ranged from 0 to 11.
- Achieved an AUROC of 0.85 in the derivation set and 0.83 in the validation set.
- RRT rates increased significantly with higher RAT scores (e.g., 20% at score 10).
Conclusions:
- The RAT score is a novel, validated tool for predicting RRT in trauma patients.
- It can assist in managing RRT resource allocation, especially during high-demand periods.
- Future iterations may incorporate baseline renal function for enhanced prediction.
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