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Griffin KL, Richardson C, Brierley S, Stullich RM, Gates RL. Validation for Abbreviated Hospital Stay in Pediatric Patients with Solid Organ Injury. Am Surg 2023; 89:5921-5926. [PMID: 37257502 DOI: 10.1177/00031348231180935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND In 2000, the American Pediatric Surgical Association (APSA) published guidelines for the management of pediatric solid organ injury, recommending a hospital length of stay (LOS) of grade of injury plus 1 day. Since the publication of these guidelines, several studies have suggested that it is safe to discharge patients sooner based upon hemodynamic and clinical factors. The results of several of these studies have been confounded by the existence of other injuries. The aim of this study was to examine LOS and outcomes in children with strictly isolated solid organ injuries. MATERIALS AND METHODS This is a 12-year retrospective review of pediatric patients with isolated trauma to the kidney, liver, or spleen to determine LOS. Patients were excluded for associated intracranial, neurologic, orthopedic, or pulmonary injuries which would impact length of stay. Documented hemodynamic parameters were reviewed as determinants of patient stability. RESULTS A total of 156 patients were included in the study. The projected average LOS for all patients based on the 2000 APSA guidelines would have been 3.71 ± 0.98 days. The actual average LOS for all patients 2.85 ± 3.32 days. Need for operation, ICU stay, and transfusion all contributed to increased LOS. The number of episodes of abnormal vitals positively correlated with increased LOS. DISCUSSION This study validates that management of isolated solid organ injuries based upon hemodynamic parameters and clinical status is safe and decreases hospital length of stay. Consistently normal vital signs indicate these children can be safely discharged sooner.
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Affiliation(s)
| | | | | | - Renee M Stullich
- School of Medicine, University of South Carolina, Greenville, SC, USA
| | - Robert L Gates
- Prisma Health Upstate, Greenville, SC, USA
- School of Medicine, University of South Carolina, Greenville, SC, USA
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2
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Ringen AH, Fatland A, Skaga NO, Gaarder C, Naess PA. Pediatric renal trauma: 17 years of experience at a major Scandinavian trauma center. Trauma Surg Acute Care Open 2023; 8:e001207. [PMID: 38020860 PMCID: PMC10649896 DOI: 10.1136/tsaco-2023-001207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Background Children are at increased risk of renal injuries from blunt trauma due to their anatomic constitution. The kidney is injured in 5-20% of pediatric patients with blunt abdominal trauma. During the last decades, the management of pediatric renal injuries has evolved toward non-operative management (NOM) unless the patient is hemodynamically compromised. The aim of the present study was to assess contemporary treatment strategies and evaluate outcomes in pediatric patients with renal injuries admitted to a major Scandinavian trauma center. Methods A retrospective cohort study of all trauma patients under 18 years admitted to our institution from January 1, 2003 to December 31, 2019 with main focus on patients with renal injury. Outcomes for two time periods were compared, 2003-2009 (Period 1; P1) and 2010-2019 (Period 2; P2), and the study cohort was also stratified into age groups, survivors and non-survivors and severity of renal injury. Results In total, there were 4230 pediatric patients included in Oslo University Hospital Trauma Registry during this 17-year period and of these 115 (2.7%) had a renal injury. Nephrectomy was performed in four (3.5%) of the patients, angiographic embolization five (4.3%) and ureteral stent placement was performed in six patients (5.2%) due to urinary extravasation. Seven patients died, implying a crude mortality of 6.1%, with one exception secondary to traffic-related incidents. None of the deaths were attributed to renal injury and mortality fell to 1.2% in P2. Discussion This study on contemporary pediatric renal trauma care is one of the largest from a single institution outside the USA. Our results clearly show that NOM, including minimally invasive procedures in selected cases, is achievable in more than 90% of cases with low mortality and morbidity. Level of evidence Level IV.
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Affiliation(s)
- Amund Hovengen Ringen
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - André Fatland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nils Oddvar Skaga
- Department of Anesthesia, Oslo University Hospital Ulleval, Oslo, Norway
| | - Christine Gaarder
- Department of Traumatology, Oslo University Hospital Ulleval, Oslo, Norway
| | - Paal Aksel Naess
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Traumatology, Oslo University Hospital Ulleval, Oslo, Norway
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3
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Raizandha MA, Kloping YP, Rizaldi F. Imaging modalities and management of pediatric high-grade renal trauma in an Indonesian tertiary hospital: a report of two cases and literature review. Radiol Case Rep 2022; 17:1563-1567. [PMID: 35282324 PMCID: PMC8914251 DOI: 10.1016/j.radcr.2022.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 11/24/2022] Open
Abstract
As one of the most commonly injured organs in the genitourinary system during trauma, a thorough understanding of pediatric renal trauma's diagnosis and management is essential for physicians. The improvement of imaging modalities in recent years has shifted most treatments to a conservative approach. Non-operative management could reduce the risk of nephrectomy while increasing renal salvage rate. However, high-grade pediatric renal injury management remains controversial. We aimed to report two children with high-grade renal trauma, diagnosed using computed tomography and retrograde pyelography studies, undergoing different approaches. The first patient underwent a nephrectomy, whereas the second patient underwent non-operative management.
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Affiliation(s)
- Muhammad Achdiar Raizandha
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia.,Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Yudhistira Pradnyan Kloping
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia.,Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Fikri Rizaldi
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia.,Rumah Sakit Universitas Airlangga Teaching Hospital, Surabaya, East Java, Indonesia
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Nakao S, Katayama Y, Hirayama A, Hirose T, Ishida K, Umemura Y, Tachino J, Kiguchi T, Matsuyama T, Kiyohara K, Kitamura T, Nakagawa Y, Shimazu T. Characteristics and outcomes of pediatric blunt renal trauma: a nationwide cohort study in Japan. Eur J Trauma Emerg Surg 2021; 48:2047-2057. [PMID: 34562135 DOI: 10.1007/s00068-021-01795-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/17/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to describe epidemiologic features of pediatric blunt renal trauma. METHODS We performed a retrospective analysis using the Japan Trauma Data Bank over 15 years. We included patients younger than 18 years with blunt renal trauma. We analyzed temporal trends and variations across age groups in patient characteristics, intervention, and in-hospital mortality. We also assessed factors associated with in-hospital mortality. RESULTS We identified 435 pediatric patients with blunt renal trauma. Their median age was 14 years and median Injury Severity Score (ISS) was 17. The most common mechanism of injury was traffic accident in all age groups. Nephrectomy was performed in 3.2%, and the overall in-hospital mortality was 4.6%, both of which showed decreasing trends. The most common mechanism of injury by age group was a pedestrian accident in infants/toddlers/preschoolers (43.5%), pedestrian accident in middle childhood (18.5%), bicycle accident in young teens (24.7%), and motorcycle accident in teenagers (41.2%). Sports-related injury was common in young teens (23.3%) and teenagers (15.2%). Factors such as ISS, shock, concomitant injury, and nephrectomy were associated with high in-hospital mortality. CONCLUSIONS We described decreasing trends in nephrectomy and in-hospital mortality in pediatric blunt renal trauma and found traffic accident and sports-related injury were common in the pediatric population in Japan.
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Affiliation(s)
- Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Atsushi Hirayama
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kenichiro Ishida
- Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Yutaka Umemura
- Department of Emergency and Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takeyuki Kiguchi
- Department of Emergency and Critical Care, Osaka General Medical Center, Osaka, Japan
- Kyoto University Health Service, Kyoto, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women's University, Tokyo, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yuko Nakagawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
- Department of Emergency and Critical Care, Osaka General Medical Center, Osaka, Japan
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Impact of trauma center designation in pediatric renal trauma: National Trauma Data Bank analysis. J Pediatr Urol 2020; 16:658.e1-658.e9. [PMID: 32773248 DOI: 10.1016/j.jpurol.2020.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/08/2020] [Accepted: 07/16/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The pediatric kidney is the most common urinary tract organ injured in blunt abdominal trauma. Trauma care in the United States has been established into a hierarchical system verified by the American College of Surgeons (ACS). Literature evaluating management of pediatric renal trauma across trauma tier designations is scarce. OBJECTIVE To examine the differences in the management and outcomes of renal trauma in the pediatric population based on trauma level designation across the United States. STUDY DESIGN We performed a review of the ACS - National Trauma Data Bank database. Pediatric patients (age 0-18 years) who were treated for renal injury between years 2011-2016 were identified. Our primary outcome was the difference in any complication rate amongst Level I versus Non-Level I trauma centers. Management strategies were evaluated as secondary outcomes. Propensity score matching (PSM) was utilized to adjust for baseline differences between cohorts. Multivariable regression analysis was performed to determine the independent effects of individual factors on complications, operative intervention, minimally invasive procedure, and blood transfusions. RESULTS Overall, 12,097 pediatric patients were diagnosed with renal trauma between 2011 and 2016 using target ICD-9 and AAST codes. After PSM, there was a total of 1623 subjects withing each group. No difference was identified between groups for occurrence on any complication [105 (6.5%) vs 114 (7.0%), p = 0.576. There were no differences in the rate of minimally invasive interventions [67 (4.1%) vs 48 (3.0%), p = 0.087], operative intervention [58 (3.6%) vs 68 (4.2%), p = 0.413], or nephrectomy [42 (2.6%) vs 47 (2.9%), p = 0.667] between Level I and Non-Level I trauma designations, respectively. Length of stay was longer in the Level I cohort compared to Non-Level I (days (SD)) [6.9 (8.8) vs 6.2 (7.9), p = 0.024. When specifically looking at risk factors associated with operative intervention, higher renal injury grade and injury severity score were highly correlated, whereas, trauma level designation was not found to be predictive for more aggressive management. DISCUSSION & CONCLUSION Our results corroborate with previous literature that renal injury grade and injury severity score are strong predictors of morbidity, invasive management, and complications. Pediatric renal trauma was managed similarly across trauma center designations, with the rate of complication and intervention more prevalent in patients with high grade renal injuries and concomitant injuries. Further studies are necessary to identify patients who will benefit most from transfer to a level I center.
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6
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"Functional outcome in pediatric grade IV renal injuries following blunt abdominal trauma salvaged with minimally invasive interventions". J Pediatr Urol 2020; 16:657.e1-657.e9. [PMID: 32758417 DOI: 10.1016/j.jpurol.2020.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/30/2020] [Accepted: 07/16/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Non-operative management of higher-grade renal injuries has gradually become accepted in pediatric circles following multiple studies over the past decade which showed good renal salvage rates. However, some children do fail this conservative approach and need interventions which are mostly minimally invasive. There is still paucity of studies on the functional outcomes in this unique subgroup of patients. In this study, we review our management and functional outcome of children with grade IV renal injury due to blunt trauma of abdomen managed with minimally invasive interventions (MII) in a tertiary referral center. AIM The present study seeks to summarize contemporary management of pediatric grade IV renal injury due to blunt trauma at our tertiary care center and to assess the functional outcomes in the subgroup who needed MII. MATERIALS AND METHODS A retrospective review was performed on children≤18 years with abdominal blunt trauma managed at our tertiary care facility over the past 10 years (January 2008-January 2018) to identify those with grade IV renal injuries. Data collected included demographic data like age, sex, mechanism of injury, incidence of hematuria, incidence of pre-existing urologic conditions, associated non-renal injuries, transfusion requirements, imaging findings, type of interventions, length of hospital stay, complications and outcomes on follow up. RESULTS Review of our institutional database identified 10 children with grade IV renal injury. Mean age was 11.7 ± 3.6 years (range, 6-18) and majority (6/10) were male. Motor vehicle collision and fall from heights were the commonest mechanisms of injury. While one patient responded to non-operative management, one girl needed emergency renal exploration and later nephrectomy. Eight needed minimally invasive interventions following initial non-operative management. One patient needed nephrectomy due to delayed hemorrhage while three patients needed delayed open reconstruction. The salvage rate in the group which needed interventions was 87.5% (7 of 8) however, the functional outcome was good only in 50% (4 of 8) of patients. The outcomes were better in those who were managed with MII earlier (3/4) compared to those who underwent delayed intervention (1/4). The median hospital stay was 11.5 days (range 7-34 days). CONCLUSION Pediatric patients with non-exsanguinating grade IV renal injuries due to blunt trauma who fail non-operative management and need minimal invasive interventions have good renal salvage rates however, the functional outcomes are poorer. Judicious and early use of these minimally invasive interventions, instead of persisting with non-operative management can possibly improve these functional outcomes.
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7
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Farr BJ, Armstrong LB, Barnett SC, Mooney DP. Variation in management of pediatric post-traumatic urine leaks. Eur J Trauma Emerg Surg 2020; 48:173-178. [PMID: 32623483 DOI: 10.1007/s00068-020-01430-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/28/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE High-grade pediatric renal trauma may be associated with a urine leak and appropriate management remains unclear. METHOD Data on patients with a traumatic renal injury were retrieved from the trauma registry and data warehouse of a pediatric level 1 trauma center over a 15-year period. Demographics, diagnoses, imaging, interventions performed, and follow-up information on patients with a urine leak were analyzed. RESULTS 187 renal injuries were identified and 32 (17%) were high grade. There were 21 (11%) diagnoses of urine leak, comprising the study population. Leaks were identified 0-10 day post-injury. All patients underwent initial computerized tomography (CT); however, 10 (48%) lacked excretory-phase imaging, leading to repeat CT. Ten patients (48%) did not undergo an intervention for their leak, and 11 (52%) underwent at least one, most commonly stent placement (10). Comparing non-intervention and intervention groups: Injury Severity Score (ISS) and initial Shock Index - Pediatric Adjusted (SIPA) were similar, but there was variation in antibiotic prophylaxis (60% vs 100%), average number of imaging studies performed (6.4 vs 8.1) and average length of hospital stay in days (7.7 vs 8.6). CONCLUSION Traumatic urine leaks are unusual, and half require no intervention. Management is variable and the development of care guidelines could decrease variation. Given their infrequency a multi-institutional study is required to generate sufficient patient volume.
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Affiliation(s)
- Bethany J Farr
- Department of Surgery, Boston Children's Hospital, Fegan 3, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | | | - Samuel C Barnett
- Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
| | - David P Mooney
- Department of Surgery, Boston Children's Hospital, Fegan 3, 300 Longwood Avenue, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
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Psooy K, Franc-Guimond J, Kiddoo D, Lorenzo A, MacLellan D. Canadian Urological Association Best Practice Report: Sports and the solitary kidney - What primary caregivers of a young child with a single kidney should know (2019 update). Can Urol Assoc J 2019; 13:315-317. [PMID: 31603410 PMCID: PMC6788919 DOI: 10.5489/cuaj.6118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Karen Psooy
- Division of Pediatric Urology, Winnipeg Children’s Hospital, Winnipeg, MB, Canada
| | - Julie Franc-Guimond
- Division of Pediatric Urology, Department of Surgery, University of Montreal, QC, Canada
| | - Darcie Kiddoo
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Armando Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Dawn MacLellan
- Department of Urology, Dalhousie University, Halifax, NS, Canada
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Gates RL, Price M, Cameron DB, Somme S, Ricca R, Oyetunji TA, Guner YS, Gosain A, Baird R, Lal DR, Jancelewicz T, Shelton J, Diefenbach KA, Grabowski J, Kawaguchi A, Dasgupta R, Downard C, Goldin A, Petty JK, Stylianos S, Williams R. Non-operative management of solid organ injuries in children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee systematic review. J Pediatr Surg 2019; 54:1519-1526. [PMID: 30773395 DOI: 10.1016/j.jpedsurg.2019.01.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/14/2019] [Accepted: 01/19/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE The American Pediatric Surgical Association (APSA) guidelines for the treatment of isolated solid organ injury (SOI) in children were published in 2000 and have been widely adopted. The aim of this systematic review by the APSA Outcomes and Evidence Based Practice Committee was to evaluate the published evidence regarding treatment of solid organ injuries in children. METHODS A comprehensive search strategy was crafted and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were utilized to identify, review, and report salient articles. Four principal questions were examined based upon the previously published consensus APSA guidelines regarding length of stay (LOS), activity level, interventional radiologic procedures, and follow-up imaging. A literature search was performed including multiple databases from 1996 to 2016. RESULTS LOS for children with isolated solid organ injuries should be based upon clinical findings and may not be related to grade of injury. Total LOS may be less than recommended by the previously published APSA guidelines. Restricting activity to grade of injury plus two weeks is safe but shorter periods of activity restriction have not been adequately studied. Prophylactic embolization of SOI in stable patients with image-confirmed arterial extravasation is not indicated and should be reserved for patients with evidence of ongoing bleeding. Routine follow-up imaging for asymptomatic, uncomplicated, low-grade injured children with abdominal blunt trauma is not warranted. Limited data are available to support the need for follow-up imaging for high grade injuries. CONCLUSION Based upon review of the recent literature, we recommend an update to the current APSA guidelines that includes: hospital length of stay based on physiology, shorter activity restrictions may be safe, minimizing post-injury imaging for lower injury grades and embolization only in patients with evidence of ongoing hemorrhage. TYPE OF STUDY Systematic Review. LEVELS OF EVIDENCE Levels 2-4.
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Affiliation(s)
- Robert L Gates
- University of South Carolina School of Medicine - Greenville, Greenville, SC
| | - Mitchell Price
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | | | - Stig Somme
- Division of Pediatric Surgery, Children's Hospital of Colorado, Aurora, CO
| | - Robert Ricca
- Division of Pediatric Surgery, Naval Medical Center Portsmouth, Portsmouth, VA
| | - Tolulope A Oyetunji
- University of Missouri - Kansas City School of Medicine, Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Yigit S Guner
- University of California - Irvine, Division of Pediatric and Thoracic Surgery, Children's Hospital of Orange County, Irvine, CA
| | - Ankush Gosain
- Division of Pediatric Surgery, University of Tennessee Health Science Center, Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN
| | - Robert Baird
- Department of Pediatric General and Thoracic Surgery, The British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Dave R Lal
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Tim Jancelewicz
- Division of Pediatric Surgery, University of Tennessee Health Science Center, Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN
| | - Julia Shelton
- Division of Pediatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Karen A Diefenbach
- Department of Pediatric Surgery, Nationwide Children's Hospital and The Ohio State University, Columbus, OH
| | - Julia Grabowski
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University, Chicago, IL
| | - Akemi Kawaguchi
- Department of Pediatric Surgery, McGovern School of Medicine, University of Texas at Houston, Houston, TX
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Cynthia Downard
- Division of Pediatric Surgery, Hiram C. Polk, Jr, MD Department of Surgery, University of Louisville, Louisville, KY
| | - Adam Goldin
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA
| | - John K Petty
- Wake Forest University School of Medicine, Childress Institute for Pediatric Trauma, Winston-Salem, NC
| | - Steven Stylianos
- Department of Surgery, Division of Pediatric Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY
| | - Regan Williams
- Division of Pediatric Surgery, University of Tennessee Health Science Center, Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN.
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Hagedorn JC, Fox N, Ellison JS, Russell R, Witt CE, Zeller K, Ferrada P, Draus JM. Pediatric blunt renal trauma practice management guidelines: Collaboration between the Eastern Association for the Surgery of Trauma and the Pediatric Trauma Society. J Trauma Acute Care Surg 2019; 86:916-925. [PMID: 30741880 DOI: 10.1097/ta.0000000000002209] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Injury to the kidney from either blunt or penetrating trauma is the most common urinary tract injury. Children are at higher risk of renal injury from blunt trauma than adults, but no pediatric renal trauma guidelines have been established. The authors reviewed the literature to guide clinicians in the appropriate methods of management of pediatric renal trauma. METHODS Grading of Recommendations Assessment, Development and Evaluation methodology was used to aid with the development of these evidence-based practice management guidelines. A systematic review of the literature including citations published between 1990 and 2016 was performed. Fifty-one articles were used to inform the statements presented in the guidelines. When possible, a meta-analysis with forest plots was created, and the evidence was graded. RESULTS When comparing nonoperative management versus operative management in hemodynamically stable pediatric patient with blunt renal trauma, evidence suggests that there is a reduced rate of renal loss and blood transfusion in patients managed nonoperatively. We found that in pediatric patients with high-grade American Association for the Surgery of Trauma grade III-V (AAST III-V) renal injuries and ongoing bleeding or delayed bleeding, angioembolization has a decreased rate of renal loss compared with surgical intervention. We found the rate of posttraumatic renal hypertension to be 4.2%. CONCLUSION Based on the completed meta-analyses and Grading of Recommendations Assessment, Development and Evaluation profile, we are making the following recommendations: (1) In pediatric patients with blunt renal trauma of all grades, we strongly recommend nonoperative management versus operative management in hemodynamically stable patients. (2) In hemodynamically stable pediatric patients with high-grade (AAST grade III-V) renal injuries, we strongly recommend angioembolization versus surgical intervention for ongoing or delayed bleeding. (3) In pediatric patients with renal trauma, we strongly recommend routine blood pressure checks to diagnose hypertension. This review of the literature reveals limitations and the need for additional research on diagnosis and management of pediatric renal trauma. LEVEL OF EVIDENCE Guidelines study, level III.
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Affiliation(s)
- Judith C Hagedorn
- From the Department of Urology (J.C.H.), University of Washington, Seattle, Washington; Division of Pediatric Surgery, Department of Surgery (N.F.), Cooper University, Camden, New Jersey; Children's Hospital of Wisconsin and Medical College of Wisconsin (J.S.E.), Milwaukee, Wisconsin; Department of Surgery (R.R.), Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, Alabama; Department of Surgery (C.E.W.), University of Washington, Seattle, Washington; Department of Surgery (K.Z.), Section of Pediatric Surgery, Wake Forest School of Medicine, Wake Forest, North Carolina; Department of Surgery (P.F.), Virginia Commonwealth University, Richmond, Virginia; and Division of Pediatric Surgery, Department of Surgery (J.M.D.), University of Kentucky, Lexington, Kentucky
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11
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Riyat H, Jones R, Sarkar D, Stephenson R. Renal injury in a patient with lumbar scoliosis. BMJ Case Rep 2018; 2018:bcr-2017-223397. [PMID: 29563127 DOI: 10.1136/bcr-2017-223397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Kidney laceration following blunt trauma is responsible for up to 3% of trauma cases. The risk factors associated with renal injury are attributed to the risks of mechanical injury. However, anatomical variations that may accelerate the insult of injury are poorly documented. This case report describes a 25-year-old with degenerative lumbar scoliosis who presented with flank pain and visible haematuria following a low-impact injury. The patient had a grade IV renal injury. The curvature of the spine, shown on CT imaging, revealed a reduced retroperitoneal space around the left kidney. This case explores lumbar scoliosis as a risk factor for kidney laceration. We hypothesise that this increased risk is associated with asymmetry of the spine and reduced anatomical space in the retroperitoneum. Patients with lumbar scoliosis may be considered a high-risk category for renal injury, following low-impact trauma.
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Affiliation(s)
- Harjoat Riyat
- General practice, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - Richard Jones
- Urology, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - Debashis Sarkar
- MSc Advanced Surgical Practice, Cardiff University, Cardiff, UK.,Department of Urology, Wirral University Hospital, Wirral, UK
| | - Richard Stephenson
- Urology, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
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