1. Management of pediatric renal trauma: Results from the American Association for Surgery and Trauma Multi-Institutional Pediatric Acute Renal Trauma Study
- Author
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Hwang, Catalina K, Matta, Rano, Woolstenhulme, Jonathan, Britt, Alexandra K, Schaeffer, Anthony J, Zakaluzny, Scott A, Kleber, Kara Teresa, Sheikali, Adam, Flynn-O'Brien, Katherine T, Sandilos, Georgianna, Shimonovich, Shachar, Fox, Nicole, Hess, Alexis B, Zeller, Kristen A, Koberlein, George C, Levy, Brittany E, Draus, John M, Sacks, Marla, Chen, Catherine, Luo-Owen, Xian, Stephens, Jacob Robert, Shah, Mit, Burks, Frank, Moses, Rachel A, Rezaee, Michael E, Vemulakonda, Vijaya M, Halstead, N Valeska, LaCouture, Hunter M, Nabavizadeh, Behnam, Copp, Hillary, Breyer, Benjamin, Schwartz, Ian, Feia, Kendall, Pagliara, Travis, Shi, Jennifer, Neuville, Paul, and Hagedorn, Judith C
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Kidney Disease ,Pediatric ,Physical Injury - Accidents and Adverse Effects ,7.3 Management and decision making ,Injuries and accidents ,Humans ,Male ,Female ,Child ,Retrospective Studies ,United States ,Kidney ,Injury Severity Score ,Trauma Centers ,Adolescent ,Wounds ,Nonpenetrating ,Child ,Preschool ,Infant ,Multi-institutional ,pediatric trauma ,renal trauma ,trauma centers ,conservative management ,Clinical sciences ,Nursing - Abstract
BackgroundPediatric renal trauma is rare and lacks sufficient population-specific data to generate evidence-based management guidelines. A nonoperative approach is preferred and has been shown to be safe. However, bleeding risk assessment and management of collecting system injury are not well understood. We introduce the Multi-institutional Pediatric Acute Renal Trauma Study (Mi-PARTS), a retrospective cohort study designed to address these questions. This article describes the demographics and contemporary management of pediatric renal trauma at Level I trauma centers in the United States.MethodsRetrospective data were collected at 13 participating Level I trauma centers on pediatric patients presenting with renal trauma between 2010 and 2019. Data were gathered on demographics, injury characteristics, management, and short-term outcomes. Descriptive statistics were used to report on demographics, acute management, and outcomes.ResultsIn total, 1,216 cases were included in this study. Of all patients, 67.2% were male, and 93.8% had a blunt injury mechanism. In addition, 29.3% had isolated renal injuries, and 65.6% were high-grade (American Association for the Surgery of Trauma Grades III-V) injuries. The mean Injury Severity Score was 20.5. Most patients were managed nonoperatively (86.4%), and 3.9% had an open surgical intervention, including 2.7% having nephrectomy. Angioembolization was performed in 0.9%. Collecting system intervention was performed in 7.9%. Overall mortality was 3.3% and was only observed in patients with multiple injuries. The rate of avoidable transfer was 28.2%.ConclusionThe management and outcomes of pediatric renal trauma lack data to inform evidence-based guidelines. Nonoperative management of bleeding following renal injury is a well-established practice. Intervention for renal trauma is rare. Our findings reinforce differences from the adult population and highlights opportunities for further investigation. With data made available through Mi-PARTS, we aimed to answer pediatric specific questions, including a pediatric-specific bleeding risk nomogram, and better understanding indications for interventions for collecting system injuries.Level of evidencePrognostic and Epidemiological; Level IV.
- Published
- 2024