LAUSR

BACKGROUND Stress on the healthcare system requires careful allocation of resources such as renal replacement therapy (RRT). The COVID-19 pandemic generated difficulty securing access to RRT for trauma patients. We sought to develop a renal replacement after trauma (RAT) scoring tool to help identify trauma patients who may require RRT during their hospitalization. STUDY DESIGN The 2017-2020 Trauma Quality Improvement Program (TQIP) database was divided into a derivation (2017-2018 data) and validation (2019-2020 data) set. A three-step methodology was used. Adult trauma patients admitted from the emergency department (ED) to the operating room or intensive care unit were included. Patients with chronic kidney disease, transfers from another hospital, and ED deaths were excluded. Multiple logistic regression models were created to determine the risk for RRT in trauma patients. The weighted average and relative impact of each independent predictor was used to derive a RAT score, which was validated using area under receiver-operating characteristic curve (AUROC). RESULTS From 398,873 patients in the derivation and 409,037 patients in the validation set, 11 independent predictors of RRT were included in the RAT score derived with scores ranging from 0-11. The AUROC for the derivation set was 0.85. The rate of RRT increased to 1.1%, 3.3%, and 20% at scores of 6, 8, and 10, respectively. The validation set AUROC was 0.83. CONCLUSION RAT is a novel and validated scoring tool to help predict the need for RRT in trauma patients. With future improvements including baseline renal function and other variables, the RAT tool may help prepare for the allocation of RRT machines/staff during times of limited resources.