Grimsby Gwen M, Voelzke Bryan, Hotaling James, Sorensen Mathew D, Koyle Martin, Jacobs Micah A
Division of Pediatric Urology, Department of Urology, UT Southwestern Medical Center, Dallas, Texas.
Department of Urology, University of Washington School of Medicine, Seattle, Washington.
J Urol. 2014 Nov;192(5):1498-502. doi: 10.1016/j.juro.2014.05.103. Epub 2014 Jun 5.
There is a lack of national data describing the demographics and nature of pediatric renal trauma. We used the National Trauma Data Bank to analyze mechanisms and grades of injury, demographics and treatment characteristics of pediatric renal trauma cases.
Renal injuries were identified by Abbreviated Injury Scale codes and converted to American Association for the Surgery of Trauma renal injury grades. Patients were stratified by age (0 to 1, 2 to 4, 5 to 14 and 15 to 18 years) for more specific analyses of mechanisms and grades of injury. Data reviewed included mechanisms and grades of renal injury, demographics, and setting and type of treatment.
A total of 2,213 pediatric renal injuries were converted to American Association for the Surgery of Trauma grade. Mean ± SD age at injury was 13.7 ± 4.4 years, with 2,089 patients (94%) being 5 to 18 years old. Of the injuries 79% were grade I, II or III. Penetrating injury accounted for less than 10% of all pediatric renal injuries. A majority of patients (57%) were admitted to university hospitals with a dedicated trauma service (73%) and only 12% of patients were admitted to a pediatric hospital. A total of 122 nephrectomies (5.5%) were performed.
Most renal trauma in children is low grade, is blunt in nature and occurs after age 5 years. The majority of these cases are managed at adult hospitals. Although most patients are treated conservatively, the rate of nephrectomy is 3 times higher at adult hospitals than at pediatric centers.
缺乏描述小儿肾创伤人口统计学特征及性质的全国性数据。我们利用国家创伤数据库分析小儿肾创伤病例的损伤机制、分级、人口统计学特征及治疗特点。
通过简明损伤定级代码识别肾损伤，并将其转换为美国创伤外科协会肾损伤分级。按年龄（0至1岁、2至4岁、5至14岁和15至18岁）对患者进行分层，以便更具体地分析损伤机制和分级。审查的数据包括肾损伤的机制和分级、人口统计学特征以及治疗环境和类型。
总共2213例小儿肾损伤被转换为美国创伤外科协会分级。受伤时的平均年龄±标准差为13.7±4.4岁，其中2089例患者（94%）年龄在5至18岁之间。在这些损伤中，79%为I级、II级或III级。穿透伤占所有小儿肾损伤的比例不到10%。大多数患者（57%）被收治到设有专门创伤服务的大学医院（73%），只有12%的患者被收治到儿科医院。总共进行了122例肾切除术（5.5%）。
儿童期的大多数肾创伤为低级别，性质为钝性，且发生在5岁以后。这些病例大多数在成人医院接受治疗。虽然大多数患者采用保守治疗，但成人医院的肾切除率比儿科中心高3倍。
