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Sports participation and high grade renal injuries in children
Robert E Gerstenbluth1, J Patrick Spirnak, Jack S Elder
1Department of Urology, Rainbow Babies and Children's Hospital, MetroHealth Medical Center, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA.
Insights
Bicycle riding is the leading cause of sports-related pediatric renal injuries, often resulting in severe trauma. Parents of children with a solitary kidney should consider this risk before allowing participation in cycling activities.
Area of Science:
- Pediatric Urology
- Sports Medicine
- Trauma Surgery
Background:
- The risk of major renal injury from sports participation in children is not well-established.
- Urologists often advise against contact sports for children with a solitary kidney.
Purpose of the Study:
- To investigate the association between different sports activities and high-grade renal injuries in children.
- To determine the specific risks posed by various sports to pediatric renal health.
Main Methods:
- Retrospective review of medical records for 68 children with blunt renal injury at two Level I trauma centers.
- Injuries were graded using the American Association for the Surgery of Trauma (AAST) renal injury scale.
- Statistical analysis included Fisher's exact test and Wilcoxon rank sum test.
Main Results:
- Bicycle riding was the most common sports-related cause (14/68 injuries), accounting for 8 cases.
- High-grade renal injuries (Grade IV or V) occurred in 62.5% of bicycle-related trauma versus 16.7% for other sports (p=0.14).
- Bicycle injuries had higher injury severity scores (mean 20.6) compared to other sports (mean 6.7).
Conclusions:
- Bicycle riding presents a significant risk for major pediatric renal injury.
- Team contact sports are rarely associated with high-grade renal injuries.
- Recommendations for sports participation in children with a solitary kidney may require reevaluation.
Purpose:
The risk of major renal injury resulting from various forms of sports participation is unknown. Urologists often recommend that children with a solitary kidney avoid contact sports. We reviewed our recent experience with pediatric renal trauma to determine if there is an association between different types of sports activity and high grade renal injury.
Materials And Methods:
We retrospectively reviewed the medical records of 68 consecutive children with blunt renal injury who were treated at 2 level I trauma centers. Injuries were graded using the renal injury scale of the American Association for the Surgery of Trauma. Records were reviewed for mechanism of injury, associated injuries, management and injury severity score. Statistical analysis was performed using Fisher's exact test or Wilcoxon rank sum test.
Results:
Of the 68 renal lesions 13 were grade I, 15 grade II, 15 grade III, 17 grade IV and 8 grade V. The most common cause of renal trauma was motor vehicle accidents, accounting for 21 injuries (30.1%). Accidents associated with nonmotorized sports activity accounted for 14 injuries (20.6%). Bicycle riding was the most common sports etiology, accounting for 8 of 14 cases (57.1%) at an age range of 5 to 15 years (mean 9.4). None of the bicycle injuries involved collision with a motor vehicle. Bicycling accounted for 1 grade I, 1 grade II, 1 grade III, 2 grade IV and 3 grade V injuries. Football, hockey and sledding were responsible for the remaining 6 sports related injuries. High grade renal injury (grade IV or V) was identified in 5 of 8 bicycle accidents (62.5%) and 1 of 6 nonbicycle sports related injuries (16.7%, p = 0.14). Injury severity scores ranged from 4 to 50 (mean 20.6) for bicycle renal injuries and 4 to 13 (mean 6.7) for nonbicycle sports related trauma (p <0.05). Parents indicated that blunt trauma from the handlebars was the major factor contributing to renal injury in 3 bicycle cases. Renal trauma from bicycle riding resulted in 1 nephrectomy.
Conclusions:
Bicycle riding is the most common sports related cause of renal injury in children and is associated with a significant risk of major renal injury. Families of children with a solitary kidney should be aware of this risk factor. Team contact sports are an uncommon cause of high grade renal injury. Current recommendations regarding sports participation by children with a solitary kidney need to be reevaluated.