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Outcomes of Severe Acute Kidney Injury in Pediatric Trauma Patients; The Trauma Quality Improvement Program Database
Nasim Ahmed1, Yen-Hong Kuo2, Roy O Mathew3
1Hackensack Meridian School of Medicine, Nutley, NJ, USA; Department of Surgery, Division of Trauma & Surgical Critical Care, USA.
Insights
Severe acute kidney injury (sAKI) in pediatric trauma patients did not increase in-hospital mortality but significantly prolonged hospital stays and increased deep vein thrombosis (DVT) risk.
Area of Science:
- Pediatric Trauma Care
- Nephrology
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) is linked to poor outcomes in trauma patients.
- Limited data exists on severe AKI (sAKI) outcomes in pediatric trauma.
- This study investigates the association between sAKI and mortality in pediatric trauma.
Purpose of the Study:
- To evaluate the impact of severe acute kidney injury (sAKI) on mortality in pediatric trauma patients.
- To compare outcomes, including mortality and complications, between pediatric trauma patients with and without sAKI.
Main Methods:
- Retrospective cohort study using the Trauma Quality Improvement Program (TQIP) database.
- Included patients under 18 years old admitted after injury.
- Propensity score matching was used to compare sAKI and no sAKI groups.
Main Results:
- Out of 139,832 patients, 106 (0.1%) had sAKI.
- No significant difference in in-hospital mortality between sAKI and no sAKI groups (14.3% vs. 12.4%).
- sAKI patients experienced significantly longer hospital stays (27 vs. 10 days) and higher rates of deep vein thrombosis (DVT) (12.4% vs. 2.9%).
Conclusions:
- Severe AKI in pediatric trauma does not increase in-hospital mortality.
- sAKI is associated with a threefold increase in hospital length of stay.
- Pediatric trauma patients with sAKI have a fourfold higher incidence of DVT.
Introduction:
Acute kidney injury (AKI) has been associated with higher mortality and morbidity in trauma victims. There is a paucity of information regarding the outcomes of severe AKI (sAKI) in pediatric trauma patients. Therefore, the trauma quality improvement program database (TQIP) was used to assess that hypothesis sAKI will be associated with higher mortality among pediatric trauma patients.
Methods:
The TQIP database was accessed for the study. Patients aged <18 years old admitted to the hospital after sustaining injury were included in the study. Demographics, injury severity score (ISS) and Glasgow coma scale (GCS) score, other body regions injuries, and available comorbidities were included in the study. Propensity score matching analysis was performed to compare the two groups, sAKI vs. no sAKI on patients' characteristics and outcomes. All p values are two-sided. A p-value <0.05 is considered statistically significant.
Results:
Out of 139,832 patients who qualified for the study, 106 (0.1%) patients suffered from sAKI. Pair-matched analysis showed no significant difference between the groups, sAKI, and no sAKI, regarding the in-hospital mortality (14.3% vs. 12.4%, P = 0.838). There was a prolonged hospital length of stay in the sAKI group when compared to the no sAKI group, (27 days [21-33] vs. 10 [9-14], P < 0.001). There was a higher incidence of deep vein thrombosis (DVT) (12.4% vs. 2.9%, P = 0.024) in the sAKI group as well.
Conclusion:
The sAKI patients stayed in the hospital approximately three times longer and had a 4-fold increase in the occurrence of DVT. No significant difference was found between the groups in in-hospital mortality.
Type Of Study:
Retrospective cohort study.
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