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Characteristics and Management of Blunt Renal Injury in Children
Yuichi Ishida1, Alan H Tyroch1, Nader Emami1
1Department of Surgery, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA.
Insights
Blunt renal trauma is uncommon in children, often associated with other abdominal injuries. Most cases are low-grade and managed conservatively, with a lower nephrectomy rate than in adults.
Area of Science:
- Pediatric Trauma Surgery
- Renal Injury Management
- Blunt Abdominal Trauma
Background:
- Pediatric renal trauma predominantly results from blunt force injuries.
- Understanding associated injuries, features, incidence, management, and outcomes is crucial.
Purpose of the Study:
- To determine the characteristics of pediatric blunt renal injuries.
- To analyze associated injuries, management strategies, and outcomes at a Level I trauma center.
Main Methods:
- Retrospective review of pediatric blunt renal injuries from January 2001 to June 2014.
- Data collected from chart and trauma registry at a regional Level I trauma center.
Main Results:
- 1.2% of pediatric blunt trauma admissions (68 children) sustained renal trauma.
- Most injuries were low-grade; nephrectomy rate was 2.9%.
- Associated intra-abdominal injuries, particularly to the liver and spleen, were common.
Conclusions:
- Blunt renal trauma in children is infrequent and typically low-grade.
- Conservative management is often successful, with a lower nephrectomy rate compared to adults.
- Close monitoring for associated intra-abdominal injuries is essential.
Background:
Renal trauma in the pediatric population is predominately due to blunt mechanism of injury. Our purpose was to determine the associated injuries, features, incidence, management, and outcomes of kidney injuries resulting from blunt trauma in the pediatric population in a single level I trauma center.
Methods:
This was a retrospective chart and trauma registry review of all pediatric blunt renal injuries at a regional level I trauma center that provides care to injured adults and children. The inclusion dates were January 2001-June 2014.
Results:
Of 5790 pediatric blunt trauma admissions, 68 children sustained renal trauma (incidence: 1.2%). Only two had nephrectomies (2.9%). Five renal angiograms were performed, only one required angioembolization. Macroscopic hematuria rate was significantly higher in the high-grade injury group (47% vs. 16%; P = 0.031). Over half of the patients had other intra-abdominal injuries. The liver and spleen were the most frequently injured abdominal organs.
Conclusion:
Blunt renal trauma is uncommon in children and is typically of low American Association for the Surgery of Trauma injury grade. It is commonly associated with other intra-abdominal injuries, especially the liver and the spleen. The nephrectomy rate in pediatric trauma is lower compared to adult trauma. Most pediatric blunt renal injury can be managed conservatively by adult trauma surgeons.
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