Intervention following pediatric high-grade renal trauma: a multicenter, retrospective analysis from the traumatic renal injury collaborative in kids (TRICK) consortium
Tyler Gaines, MD1, Jacob Lucas, DO2, Jeffrey Ellis, MD3, Ching Man Carmen Tong, DO4, Albert Lee, DO5, Christopher Long, MD6, Vinaya Bhatia, MD7, Benjamin Abelson, MD8, Douglass Clayton, MD9, Gabriella Crane, MD9, Jonathan Gerber, MD10, Harold N. Lovvorn, MD9, Ming Hsien Wang, MD11, David M. Kitchens, MD4, Christina Ho, MD12, Michael Nance, MD6, Dana Weiss, MD6.
1Einstein Healthcare Network, Philadelphia, PA, USA, 2Baylor Scott & White, Temple, TX, USA, 3Loyola University Medical Center, Chicago, IL, USA, 4Children's of Alabama, Birmingham, AL, USA, 5Texas Children's Hospital, Houston, TX, USA, 6Children's Hospital of Philadelphia, Philadelphia, PA, USA, 7University of Wisconsin - Madison, Madison, WI, USA, 8Phoenix Children's Hospital, Phoenix, AZ, USA, 9Vanderbilt Children's Hospital, Nashville, TN, USA, 10University of Texas Medical Branch, Webster, TX, USA, 11Johns Hopkins University, Baltimore, MD, USA, 12Children's National, Washington DC, DC, USA.
INTRODUCTION
The kidney is the most commonly injured organ of the urinary tract, accounting for 10% of all injuries in pediatric abdominal trauma. There is sparse pediatric specific data on the best management for high grade renal trauma. This study aimed to describe management of high-grade renal trauma in a pediatric population.
METHODS
We conducted a retrospective review of a multi-institutional database comprised of pediatric patients ages ≤ 18 years old who sustained high-grade renal injuries (American Association for Surgery of Trauma grades III-V). Data was collected on patient demographics, injury characteristics and management. Descriptive statistics were utilized to report management of renal trauma.
RESULTS
A total of 340 pediatric patients with high grade renal trauma were identified, including 326 (96%) blunt trauma and 14 (4%) penetrating injuries. Reported grade of injury included 150 (44%) grade III, 154 (45%) grade IV, and 36 (11%) grade V injuries. Most patients were managed expectantly, whereas 34 (10%) patients underwent acute intervention. Twenty-two (6%) patients underwent urologic surgery (14 ureteral stent placements, 8 nephrectomy cases) and 12 (4%) patients underwent a procedure with interventional radiology (6 diagnostic renal angiography, 6 renal embolization, 1 renal artery stent placement, 1 percutaneous drain placement). Patients with grade V injuries has the highest proportion of acute intervention at 34%, whereas procedures were much less likely to be performed in grade III and IV injuries, at 14% and 2% respectively. Thirty patients (9%) underwent a delayed procedure , with 27 patients undergoing ureteral stent placement. One delayed nephrectomy was performed. All thirty patients who underwent delayed intervention had interval imaging obtained due to persistent/worsening symptoms or evaluation of evolution of renal injury, with 19 patients with subsequent upgrade in renal injury severity.
CONCLUSION
The majority of high-grade renal injuries are managed conservatively with a non-operative approach, including grade IV and V injuries. However, a considerable number of patients may require a delayed procedure over the course of hospitalization.
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