小儿肾外伤的治疗：美国外科创伤协会多机构小儿急性肾外伤研究的结果。
Management of pediatric renal trauma: Results from the American Association for Surgery and Trauma Multi-Institutional Pediatric Acute Renal Trauma Study.
机构信息
From the Department of Urology (C.K.H.), University of Washington, Seattle, Washington; Division of Urology, Department of Surgery (R.M.), School of Medicine (J.W.), and Division of Urology, Department of Surgery (R.M., J.W., A.K.B., A.J.S.), Intermountain Primary Children's Hospital, University of Utah, Salt Lake City, Utah; Department of Surgery (S.A.Z., K.T.K.), University of California Davis, Sacramento, California; Medical College of Wisconsin, School of Medicine (A.S.); Department of Surgery (K.T.F.-O'.B.), Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin; Division of Trauma, Department of General Surgery (G.S., S.S., N.F.), Cooper University Health Care, Camden, New Jersey; Department of Surgery (A.B.H.), WakeMed, Raleigh; Department of General Surgery (K.A.Z.), Section of Pediatric Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Radiology (G.C.K.), Nemours Children's Hospital, Orlando, Florida; Division of Pediatric Surgery, Department of Surgery (B.E.L.), University of Kentucky, Lexington, Kentucky; Nemours Children's Health (J.M.D.), Jacksonville, Florida; Department of Surgery (M.S.), Department of Urology (C.C.), and Department of Surgery (X.L.-O.), Loma Linda University Medical Center and Children's Hospital, Loma Linda, California; Department of Urology (J.R.S., M.S., F.B.), Beaumont Health-Royal Oak, Royal Oak, Michigan; Department of Surgery (R.A.M., M.E.R.), Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Pediatric Urology Research Enterprise, Department of Pediatric Urology (V.M.V., N.V.H., H.M.L.), Children's Hospital Colorado; Division of Urology, Department of Surgery (V.M.V., N.V.H., H.M.L.), University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado; Department of Urology (B.N.), Cornell University; Department of Urology (H.C., B.B.), University of California San Francisco, San Francisco, California; Division of Urology (I.S., K.F., T.P.), Hennepin Healthcare, Minneapolis, Minnesota; Harborview Injury Prevention and Research Center (J.S.); and Department of Urology (P.N., J.C.H.), University of Washington, Seattle, Washington.
出版信息
J Trauma Acute Care Surg. 2024 May 1;96(5):805-812. doi: 10.1097/TA.0000000000004198. Epub 2023 Nov 15.
BACKGROUND
Pediatric renal trauma is rare and lacks sufficient population-specific data to generate evidence-based management guidelines. A nonoperative approach is preferred and has been shown to be safe. However, bleeding risk assessment and management of collecting system injury are not well understood. We introduce the Multi-institutional Pediatric Acute Renal Trauma Study (Mi-PARTS), a retrospective cohort study designed to address these questions. This article describes the demographics and contemporary management of pediatric renal trauma at Level I trauma centers in the United States.
METHODS
Retrospective data were collected at 13 participating Level I trauma centers on pediatric patients presenting with renal trauma between 2010 and 2019. Data were gathered on demographics, injury characteristics, management, and short-term outcomes. Descriptive statistics were used to report on demographics, acute management, and outcomes.
RESULTS
In total, 1,216 cases were included in this study. Of all patients, 67.2% were male, and 93.8% had a blunt injury mechanism. In addition, 29.3% had isolated renal injuries, and 65.6% were high-grade (American Association for the Surgery of Trauma Grades III-V) injuries. The mean Injury Severity Score was 20.5. Most patients were managed nonoperatively (86.4%), and 3.9% had an open surgical intervention, including 2.7% having nephrectomy. Angioembolization was performed in 0.9%. Collecting system intervention was performed in 7.9%. Overall mortality was 3.3% and was only observed in patients with multiple injuries. The rate of avoidable transfer was 28.2%.
CONCLUSION
The management and outcomes of pediatric renal trauma lack data to inform evidence-based guidelines. Nonoperative management of bleeding following renal injury is a well-established practice. Intervention for renal trauma is rare. Our findings reinforce differences from the adult population and highlights opportunities for further investigation. With data made available through Mi-PARTS, we aimed to answer pediatric specific questions, including a pediatric-specific bleeding risk nomogram, and better understanding indications for interventions for collecting system injuries.
LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level IV.
背景
儿科肾外伤较为罕见，缺乏足够的特定人群数据来制定基于证据的管理指南。非手术方法是首选，并且已被证明是安全的。然而，对于出血风险评估和集合系统损伤的处理尚不完全清楚。我们引入了多机构儿科急性肾外伤研究（Mi-PARTS），这是一项回顾性队列研究，旨在解决这些问题。本文描述了美国一级创伤中心儿科肾外伤的人口统计学和当代治疗方法。
方法
在 13 家参与的一级创伤中心，对 2010 年至 2019 年期间因肾外伤就诊的儿科患者进行了回顾性数据收集。收集了人口统计学、损伤特征、治疗方法和短期结局的数据。使用描述性统计方法报告人口统计学、急性处理和结局。
结果
本研究共纳入 1216 例患者。所有患者中，67.2%为男性，93.8%为钝性损伤机制。此外，29.3%为孤立性肾损伤，65.6%为高分级（美国外科创伤协会分级 III-V）损伤。平均损伤严重度评分（ISS）为 20.5。大多数患者接受非手术治疗（86.4%），3.9%接受了开放手术干预，包括 2.7%行肾切除术。血管栓塞术的使用率为 0.9%。集合系统干预的使用率为 7.9%。总死亡率为 3.3%，仅见于多发伤患者。可避免转院率为 28.2%。
结论
儿科肾外伤的治疗和结局缺乏数据来为基于证据的指南提供信息。肾损伤后非手术治疗出血是一种已确立的做法。肾外伤干预很少见。我们的研究结果强调了与成人人群的差异，并突出了进一步研究的机会。通过 Mi-PARTS 提供的数据，我们旨在回答儿科特定问题，包括儿科出血风险诺模图和更好地理解集合系统损伤干预的适应证。
证据水平
预后和流行病学；IV 级。
Zotero 插件