Trends in Renal Trauma in Pediatric Patients
Kiersten M. Craig, M.D.1, Lauren Balsamo, M.P.H.1, Dix P. Poppas, M.D., F.A.C.S.2, Ardavan Akhavan, M.D., F.A.C.S.2.
1New York Presbyterian/ Weill Cornell Medicine Department of Urology, New York, NY, USA, 2Komansky Children's Hospital, Institute for Pediatric Urology New York Presbyterian/ Weill Cornell Medicine Department of Urology, New York, NY, USA.
Introduction: The purpose of this study is to evaluate the presentation, management and outcomes of pediatric patients presenting with renal trauma in the US. We hypothesize that younger patients present differently than older children.
Methods: We performed a retrospective review of patients with renal trauma in the PHIS database from 1/2004 - 12/2018 between the ages of 0 - 18 years. We identified records with ICD9 codes (pre-2015) starting with 866 and ICD10 codes (post-2015) starting with S370. Renal injury severity, age, gender, LOS, mortality, mechanism of injury, and highest level of intervention were recorded. Due to coding limitations, injuries were grouped according to AAST trauma grades, as either low- (1 - 3) or high-grade (4 - 5). Patients were divided into six age groups in accordance with the NIHHDC. Patients without documented renal trauma severity were excluded.
Results: Of 3,727 patients with renal trauma in 3,759 renal units, the majority (86.6%) had low-grade renal injuries. The most common age for presentation was 10 - 14 years for both high (44.0%) and low-grade injuries (41.3%). LOS was longest in the younger ages and decreased with increasing ages: 14.1 days (<1 year old) to 4.9 days (15 - 18 years). Overall, renal injuries were more common in males (68.6%). The proportion of high-grade injury was not significantly different between genders (p=0.944), with the exception of infants <1 year, where females were predominant (8.5% vs 0.9%, p=0.002). The overall mortality rate was 1.2% and 4.9% following low- and high-grade injuries, respectively (p<0.001). Mortality decreased with increasing age in both high- and low-grade injuries. The most common causes of injuries were MVAs, falls, and strikes. Sports-related injuries were documented in 1,226 patients (32.9%); cycling (24.4%), contact sports (21.2%), and recreation sports (17.0%) were the most common offenders. Patients with low-grade injury were more likely to be managed non-operatively than those with high-grade injuries (92.1% vs 70.1% p<0.001). Nephrostomy (2.9% vs 1.2% p<0.001), exploration (3.2% vs 1.8%, p<0.001), and nephrectomy (2.0% vs 0.75%, p<0.001), were all more likely to occur in patients with high-grade injury. Patients with penetrating injury were least likely to be managed non-operatively (67.8%) compared with MVA (91.8%), fall (89.2%), and strike trauma (96.8%) (p<0.001]). Nephrectomy was most commonly performed in patients with penetrating injuries (3.82%), falls (1.86%), and MVAs (0.65%). Concomitant non-renal abdominal injuries were reported in 1,096 patients (29.5%). Patients with both renal trauma and concomitant non-renal injury were less likely to be managed non-operatively than those with isolated kidney injuries (low grade: 74.6% vs 86.2%, p<0.001 respectively; high grade: 49.2% vs 65.7%, p=0.003 respectively). Concomitant non-renal abdominal and renal traumas were also associated with higher mortality rates than isolated kidney injuries (low grade: 2.0% vs 0.81%, p=0.006 respectively; high grade: 6.3% vs 1.9%, p=0.031 respectively).
Conclusion: The management and outcomes of renal trauma in the pediatric population vary depending on age, mechanism of injury, severity of trauma, and presence of concomitant injury.
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