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Are pediatric patients more susceptible to major renal injury from blunt trauma? A comparative study
S L Brown1, J S Elder, J P Spirnak
1Department of Urology, Rainbow Babies and Children's Hospital, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Insights
Pediatric patients are more susceptible to major renal injuries from blunt abdominal trauma than adults. This study found a significantly higher incidence of severe kidney injuries in children compared to adults.
Area of Science:
- Urology
- Trauma Surgery
- Pediatric Surgery
Background:
- Blunt abdominal trauma can cause significant renal injury.
- Understanding age-related differences in injury patterns is crucial for effective treatment.
Purpose of the Study:
- To compare the susceptibility of pediatric patients versus adults to major renal injury following blunt abdominal trauma.
- To determine if children experience more severe kidney injuries than adults.
Main Methods:
- Retrospective review of medical records for 34 children (ages 2-17) and 35 adults with blunt renal trauma.
- Renal injuries were graded using the American Association for the Surgery of Trauma organ injury scale (grades IV-V classified as major).
- Injury Severity Scores (ISS) were calculated; vascular injuries were excluded.
Main Results:
- Pediatric patients had lower mean Injury Severity Scores (16) compared to adults (22).
- A higher percentage of children (47%) sustained major renal injuries compared to adults (23%).
- Children requiring surgery for hemodynamic instability all had major renal injuries, whereas only 42% of adults undergoing surgery had major renal injuries.
Conclusions:
- Children are more likely than adults to sustain major renal injury from blunt abdominal trauma.
- The findings suggest a higher susceptibility in the pediatric population to severe renal consequences from blunt trauma.
Purpose:
We determine whether pediatric patients are more susceptible to major renal injury than adults.
Materials And Methods:
We retrospectively reviewed the medical records of 34 consecutive children 2 to 17 years old (mean age 10) and 35 consecutive adults 19 to 59 years old (mean age 32) with blunt renal trauma who presented to our 2 level I trauma centers between 1990 and 1996. Patients with incomplete charts were excluded from study. According to the organ injury scaling committee of the American Association for the Surgery of Trauma renal injuries were graded based on computerized tomography results or laparotomy findings (4 adults) with major injuries classified as grade IV or V. Vascular injuries were excluded from study. Injury severity scores were calculated using the abbreviated injury scale.
Results:
Injury severity scores ranged from 4 to 75 (mean 16) in the pediatric and 5 to 50 (mean 22) in the adult populations (p <0.01). Overall 16 of the 34 children (47%) and 8 of the 35 adults (23%) sustained major renal injuries (p <0.04). In 4 children who required surgical exploration for hemodynamic instability injury severity score ranged from 17 to 42 (mean 26) and all had major renal injuries. In 7 of the 35 adults (20%) who underwent surgical exploration because of hemodynamic instability and/or positive diagnostic peritoneal lavage injury severity score ranged from 22 to 50 (mean 34). Three of these 7 adults (42%) had major renal injuries and all had other visceral injuries at exploration.
Conclusions:
Children are more likely than adults to sustain renal injury from blunt abdominal trauma.