Predictors for Intervention in Pediatric Renal Trauma
Regan Williams, MD, MS1; Jacob McMIllan, PhD2; Thomas Boulden, MD2; Ankush Gosain, MD, PhD2
1Department of Surgery and Pediatrics, University of Tennessee Health Science Center, Memphis, TN; 2UTHSC, Memphis, TN
Background: Pediatric renal trauma is often managed utilizing the organ injury scaling (OIS) system developed for adult patients. Interventions in children may differ from the adult population; therefore, we hypothesize the predictors for intervention in children would differ from the adult grading system.
Methods: An IRB-approved, retrospective study examined predictors for intervention in children(<18 years) age with renal injuries at a Pediatric Trauma Center. Interventions included blood transfusions, angiography +/- embolization and operations. Images were reviewed to examine renal specific factors that may predict intervention. Categorical variables were compared with chi-square, and continuous variables with a Student's t-test prior to logistic regression to identify variables associated with interventions.
Results: Forty-nine children presented with renal injuries over a 7-year period. Mean age was 12.3 years with 61% male. Most patients sustained a grade III(35%) or grade IV(25%) injury. Twelve patients required intervention (stent placement:8,transfusion:3,angiography:1). None had operative hemostasis or nephrectomy. Grade of injury did not predict the need for intervention(p=0.1170). Similar to the OIS system, increasing size of perirenal hematoma was associated with intervention(p=0.045) though length of renal laceration(p=0.096), hilar involvement(p=0.586) and retroperitoneal hematoma(p=0.6497) did not. Interestingly, injury to the lower pole of the kidney was the only significant predictor of intervention(p=0.0305).
Conclusions: Grade of injury did not predict the need for intervention in children with blunt renal injuries while injury to the lower pole of the kidney did. Further studies should be conducted to develop a pediatric specific grading system for children with renal injuries to better allocate hospital resources.
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