Evolving Mechanisms of Injury and Management of Pediatric Blunt Renal Trauma - 20 Years of Experience

To review twenty years of a prospectively maintained trauma database to identify changing trends in mechanisms of renal injury, demographics, and management outcomes.

Following IRB approval, a prospectively maintained trauma database was reviewed for renal trauma patient demographics, management, and mechanisms of injury.

Data was reviewed first for the entire cohort and then incrementally to identify mechanisms of injury associated with increasing frequency or grade of injury.

A total of 228 graded renal injuries were identified from 1993-2013. The majority of renal injuries occurred in males (77. 2%) greater than 6 years of age (85. 1%). Low grade (I-III) injuries were more common (70. 6%). The most frequent mechanisms of injury identified were: falls, recreational motor vehicle (RMV) accidents, bike accidents, motor vehicle collisions, and sports accidents, in descending order of frequency. RMV-related injuries have become frequent with time despite recommendations against use in the pediatric age population. Surgical intervention was rarely necessary. Over the 20 year study period, five nephrectomies (1. 4%) were required while 10 endoscopic interventions or percutaneous drainage procedures were needed (2. 4%).

The majority of blunt pediatric renal injuries are low grade and can be managed nonoperatively. Nephrectomy is rarely required but is indicated for hemodynamic instability refractory to resuscitation. Pediatric blunt renal trauma secondary to RMV use is increasing despite recommendations against their use in the pediatric population.

Urology. 2016 Jan 26 [Epub ahead of print]

Pankaj Dangle, Thomas W Fuller, Barbara Gaines, Glenn M Cannon, Francis X Schneck, Heidi A Stephany, Michael C Ost

Division of Pediatric Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Division of Pediatric Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. , Department of Pediatric Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. , Division of Pediatric Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. , Division of Pediatric Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. , Division of Pediatric Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. , Division of Pediatric Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

PubMed

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