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Published on: February 2, 2021
Presentation, Hospital Course and Outcomes of Children With High Grade Renal Trauma- Results From the Traumatic Renal
Albert S Lee1, Nora H Broadwell1, Ching Man Carmen Tong2
1Division of Pediatric Urology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
Insights
Pediatric high-grade renal trauma (HGRT) is generally low in morbidity and mortality, often resulting from blunt trauma in males. Outcomes depend on injury severity, with variations in care across institutions.
Area of Science:
- Pediatric Urology
- Trauma Surgery
- Nephrology
Background:
- High-grade renal trauma (HGRT) in children requires comprehensive understanding for optimal management.
- Existing data on pediatric HGRT characteristics, hospital course, and outcomes are limited.
- The Traumatic Renal Injury Collaborative in Kids (TRICK) consortium offers a valuable resource for studying pediatric renal injuries.
Purpose of the Study:
- To characterize pediatric high-grade renal trauma (HGRT) using the TRICK consortium data.
- To evaluate the hospital course and outcomes associated with pediatric HGRT.
- To identify factors influencing outcomes and variations in management practices.
Main Methods:
- Retrospective cohort study utilizing a multi-center registry of pediatric HGRT (grades III-V).
- Inclusion of patients under 18 years of age with HGRT from 2007 to 2020.
- Extraction and comparison of patient demographics, presenting characteristics, hospital courses, outcomes, and follow-up data.
Main Results:
- 315 pediatric patients with HGRT were analyzed; most were male (69.5%) with blunt trauma (96.2%).
- Higher injury grades correlated with increased Injury Severity Score (ISS), need for surgical procedures, and complication rates.
- Significant variations in institutional practice patterns were observed, including imaging use, interventions, and consultations.
Conclusions:
- Pediatric HGRT exhibits low overall morbidity and mortality, predominantly affecting males via blunt trauma.
- Outcomes and hospital course are significantly influenced by renal injury grade.
- The TRICK registry provides crucial updated data for clinical decision-making and highlights areas for potential improvement in care standardization.
Objective:
To evaluate characteristics, hospital course, and outcomes of pediatric high-grade renal trauma (HGRT) using the Traumatic Renal Injury Collaborative in Kids consortium.
Methods:
This was a retrospective cohort study of a large, multi-center registry of HGRT. Patients <18 years of age with HGRT (grades III, IV, and V) from 2007 to 2020 were included. Patient demographics, presenting characteristics, hospital courses, outcomes, and follow-ups were extracted and compared.
Results:
Out of the 315 patients included, most were male (69.5%) with blunt renal trauma (96.2%). 61% of patients were transferred to a level 1 trauma center. Those with higher injury grade had higher injury severity score (ISS) (ISS 14 vs 17 vs 25; P = .003), greater need for surgical procedures (0.7% vs 8.3% vs 21.2%; P =<.001), and higher complication rates (14.6% vs 20.7% vs 33.3%; P = .043). Demographics and practice patterns differed between institutions, including ISS severity, use of delayed imaging, IR intervention, and urology consult, and repeat imaging.
Conclusion:
Pediatric HGRT has overall low morbidity and mortality. Most injuries occurred in males following blunt renal trauma secondary to motor vehicle collision. Hospital course and outcomes were dependent on renal grade, with practice patterns and follow-up differing between institutions. The current registry provides updated information on pediatric HGRT in the clinical setting for counseling and guide decision making. The differences noted in site specific management also allow for comparison across sites, identify areas of need, and to implement future improvements.
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