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The Contemporary Management of Pediatric Renal Trauma: A Retrospective 10-Year Analysis of the National Trauma Data
Nizar Hakam1, Behzad Abbasi1, Mikołaj Frankiewicz1,2
1Department of Urology, University of California San Francisco, San Francisco, California.
Insights
Pediatric renal trauma is often blunt and high-grade, with most cases managed non-operatively. Angioembolization shows promise for kidney salvage in high-grade injuries, though nephrectomy rates remain stable.
Area of Science:
- Pediatric Urology
- Trauma Surgery
- Nephrology
Background:
- Renal trauma is a significant concern in pediatric patients, often resulting from abdominal trauma.
- Limited data exists on the management and outcomes of pediatric renal injuries.
- Conservative management strategies are increasingly used in adult renal trauma.
Purpose of the Study:
- To analyze contemporary care patterns for pediatric renal trauma.
- To describe management strategies and outcomes over a 10-year period.
- To evaluate interventions for bleeding and collecting system injuries in children.
Main Methods:
- Retrospective analysis of the National Trauma Databank (NTDB) from 2013-2022.
- Inclusion of pediatric patients with renal injuries.
- Extraction and analysis of injury characteristics, management patterns, and procedural interventions.
Main Results:
- A cohort of 15,138 pediatric patients with renal injuries was analyzed.
- 89% of injuries were blunt trauma, and 67% were high-grade.
- 90% of patients were managed non-operatively; nephrectomy rate was 5.8% and stable.
- Angioembolization demonstrated higher success in avoiding further bleeding interventions for high-grade injuries compared to surgical repair.
Conclusions:
- Low-grade pediatric renal trauma is predominantly managed expectantly.
- Unlike adult data, nephrectomy rates in pediatric renal trauma did not decrease over the study period.
- Angioembolization may offer better kidney salvage rates than surgical repair in select cases, but selection bias needs consideration.
Purpose:
Conservative management of adult renal trauma with observation or angioembolization has led to a decline in nephrectomies. In children, trauma is the leading cause of mortality, and renal injury is a frequent consequence of abdominal trauma. However, data on management and outcomes of pediatric renal trauma remain limited. We sought to describe care patterns in a contemporary 10-year period of the National Trauma Data Bank.
Materials And Methods:
We evaluated pediatric renal injuries in the National Trauma Databank between 2013 and 2022. Relevant injury characteristics and kidney-related procedures, including interventions for bleeding and collecting system, were extracted. Injury characteristics, management patterns, and outcomes were analyzed and reported.
Results:
Our cohort consisted of 15,138 patients with a mean age of 13.7 (SD 4.2) years. Most injuries resulted from a blunt trauma (89%) and 67% were high grade. Overall, 90% of patients were managed nonoperatively, including 98% of those with low-grade injuries. The most common bleeding interventions were nephrectomy (n = 603, 3.9%), angioembolization (n = 324, 2.1%), and surgical repair (n = 204, 1.4%). The most common collecting system interventions were ureteral stent (n = 606, 4%), nephrostomy tube (n = 143, 0.9%), and perirenal drain (n = 122, 0.8%). Overall, the proportion of those cases receiving nephrectomy was 5.8% and was stable over the years examined. Among high-grade injuries, angioembolization (n = 294) achieved 87% success in avoiding further bleeding interventions vs 81% for surgical repair (n = 180). Nephrectomy use was lower after angioembolization vs after surgical repair. A total of 662 (4.3%) patients died, of whom 660 had associated nonkidney injuries.
Conclusions:
Almost all cases of low-grade pediatric renal trauma can be managed expectantly. In contrast to adult data in the literature, nephrectomy use did not decrease over time. In those who do receive kidney-sparing bleeding interventions, angioembolization seems to achieve higher kidney salvage; however, selection bias may limit the validity of this comparison.
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