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Factors affecting and effects of hemodynamic stability of pediatric patients with grades 3-5 renal trauma: a
Rabea Ahmed Gadelkareem1, Ahmed Hamdan2, Amr Abou Faddan2
1Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Elgamaa Street, Assiut, 71515, Egypt. dr.rabeagad@yahoo.com.
Insights
Maintaining hemodynamic stability is crucial for successful conservative management of pediatric high-grade renal trauma. Blood pressure is the key independent factor in achieving this stability, ensuring better patient outcomes.
Area of Science:
- Pediatric Urology
- Trauma Surgery
- Nephrology
Background:
- Limited research exists on hemodynamic stabilization's impact on conservative management for pediatric high-grade renal trauma.
- Conservative treatment is often preferred for pediatric renal injuries, but its success in high-grade cases depends on patient stability.
Purpose of the Study:
- To assess the effect of initial hemodynamic stability on implementing conservative management in pediatric patients with grades 3-5 renal trauma.
- To identify factors that define the achievement and maintenance of hemodynamic stability for conservative treatment.
Main Methods:
- Prospective study of pediatric patients (grades 3-5 renal trauma) from July 2020 to June 2022.
- Comparison of hemodynamically stable versus unstable patients regarding clinical characteristics, stabilization, and conservative treatment success rates.
- Statistical analysis to identify significant differences and independent predictors of hemodynamic stability.
Main Results:
- Overall, 74.4% of patients achieved or maintained hemodynamic stability for conservative management.
- Hemodynamically stable patients had significantly lower blood pressure at presentation and smaller hematoma size.
- Blood pressure was the sole independent factor associated with maintaining hemodynamic stability (p=0.022).
Conclusions:
- Hemodynamic stabilization is effective and safe for conservative management of pediatric high-grade renal trauma.
- Maintaining hemodynamic stability, particularly blood pressure, is critical for successful non-operative treatment.
- Conservative management showed comparable blood transfusion and hospital stay rates, with low rates of nephrectomy (14%) and zero mortality.
Background:
Researches on the effect of hemodynamic stabilization on the implantation of conservative management for pediatric high-grade renal traumas are lacking. We aimed to assess the effect of maintaining the initial hemodynamic stability of pediatric patients with grades 3-5 renal trauma on the implementation of the conservative treatment and identify its defining factors.
Methods:
A prospective study was performed on pediatric patients with grade 3-5 renal traumas who presented to our hospital during July 2020-June 2022. Hemodynamically stable patients were compared with the unstable patients for clinical characteristics, hemodynamic stabilization, and rates of success of conservative treatment.
Results:
Forty-three patients were studied, including 26 boys and 17 girls. Of them, 28 (65.1%) patients presented with hemodynamic stability and 15 (34.9%) patients were unstable. Overall, 32 (74.4%) patients achieved and/or maintained hemodynamic stability for conservative management. There was a significant difference in blood pressure level at presentation (p < 0.001). The improvement of the hemodynamic parameters was significant per group and, in comparison (p < 0.001). The size of hematoma was significantly smaller in patients with hemodynamic stability (p = 0.023). Despite the longer (p = 0.033) hospital stay with conservative management, the rates of blood transfusion (p = 0.597) and hospital stay (p = 0.785) were not significantly different between both groups. The rates of nephrectomy and mortality were 14% and 0%, respectively. Blood pressure was independently associated with the achievement of maintained hemodynamic stability for conservative management (p = 0.022).
Conclusions:
Hemodynamic stabilization seems to be effective and safe for implementing successful conservative management for pediatric patients with high-grade renal traumas. Blood pressure was the only independent factor of maintaining hemodynamic stability.
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