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Contemporary Management of Pediatric Renal Injuries at a Level 1 Trauma Center
Zachary Ballinger
1, Jahnavi Challagonda
1, Muriel Cleary
2, Jonathan Green
2, Kaitlyn Wong
2, Jeremy Aidlen
2
1UMass Chan Medical School, Worcester, MA, 2UMass Memorial Medical Center, Worcester, MA
Background: Angioembolization is currently recommended for hemodynamically stable pediatric blunt kidney injury patients with ongoing bleeding. This recommendation is controversial. Therefore, this study aimed to examine contemporary management of pediatric trauma patients with renal injury at a level 1 pediatric trauma center.
Methods: Demographic and key clinical characteristics were obtained from patients <18 years old in the UMass Trauma Registry between 2016-2023 with radiologically confirmed renal injury.
Results: 2342 pediatric trauma patients entered the Registry, and 29 had acute traumatic renal injuries (1.24%). See Table 1 for summary information. Average kidney injury grade was 2.5 (95% CI: 0 - 5). Although 48% of patients received a urology consultation, just 3 patients had collecting system injuries that required interventions. Splenic (28%), spine (28%), liver (21%), and rib (21%) injuries were the most common concomitant injuries. 41% of patients required surgical intervention for other organ system injuries. There were no nephrectomies and no angio-embolization. There were no complications related to a patient’s kidney injuries. Multivariate regression demonstrated increased odds of prolonged ICU stay and increased Bed Rest Days with increased Kidney injury grade, after adjustment for demographic indices, age, race, and injury cause (aOR 4.25 and 4.65, respectively).
Conclusion: Our study demonstrates that even severe renal injuries can be safely managed without nephrectomy or embolization in the pediatric population. These results should galvanize ongoing discussion around the recommended use of angio-embolization in pediatric traumatic renal injury.
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