MiGUTS model - Evidencio
MiGUTS model

High-grade kidney trauma patients (grade III-V) are treated with bleeding interventions or conservative therapy (non-interventions). Determining patients at high risk in need of bleeding interventions can help guide healthcare professionals in choosing the right therapy for patients. In addition, interventions for patients at high risk can be utilised early on and less unnecessary recources are used for conservative therapy.

The MiGUTS model determines the risk of need for bleeding interventions of patients with high-grade kidney trauma based on the mechanism of the trauma, hypotension/shock after trauma, concomitant injuries, vascular contrast extravasation, pararenal hematoma & hematoma rim distance [1].

Most of the variables in the MiGUTS model are derived from contrast-enhanced CT imaging, which is the standard diagnostic tool for evaluating high-grade renal trauma [2]. This alignment underscores the model's practicality and relevance in clinical settings, as it integrates data routinely obtained during the diagnostic process.

[1] Keihani S, Rogers DM, Putbrese BE, Moses RA, Zhang C, Presson AP, et al. A nomogram predicting the need for bleeding interventions after high-grade renal trauma: Results from the American Association for the Surgery of Trauma Multi-institutional Genito-Urinary Trauma Study (MiGUTS). J Trauma Acute Care Surg 2019;86:774–82. https://doi.org/10.1097/TA.0000000000002222.

[2] N. D. Kitrey (Chair), F. Campos-Juanatey, P. Hallscheidt, E. Mayer, E. Serafetinidis, D. M. Sharma, M. Waterloos Guidelines Associates: H. Mahmud, K. Zimmermann Guidelines Office: N. Schouten. EAU Guidelines on Urological Trauma. 2024.

Research authors: Keihani S, Rogers DM, Putbrese BE, Moses RA, Zhang C, Presson AP, et al.
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% risk of requiring bleeding interventions following high-grade renal trauma.

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The external validation study based on a European population determines a threshold of 20% for high risk patients (with AUC=0.97) [1]. Meaning that patients with a risk of 20% or higher are in need of a timely bleeding intervention. With lower risks conservative therapy should be considered.

  • Risk < 20%: Low risk patient. Consider conservative therapy.

  • Risk > 20%: High risk patient. Patient is in need of a timely bleeding intervention.

[1] Schmidli TS, Sigg S, Keihani S, Bosshard L, Prummer M, Nowag AS, et al. External validation of the MiGUTS nomogram for the prediction of bleeding control intervention after renal trauma. World J Urol 2024;42:554. https://doi.org/10.1007/s00345-024-05231-7.

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This algorithm is provided for educational, training and information purposes. It must not be used to support medical decision making, or to provide medical or diagnostic services. Read our full disclaimer.

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