Patel Mann, Glassman Taylor, Burjonrappa Sathyaprasad
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Department of Paediatric Surgery, Medical Education Building, Rm 500, Rutgers, RWJMS, New Brunswick, NJ, 08901, USA.
J Pediatr Surg. 2025 Mar;60(3):162024. doi: 10.1016/j.jpedsurg.2024.162024. Epub 2024 Oct 20.
This study aimed to evaluate contemporary management strategies of pediatric renal trauma, focusing on the failure of conservative management and identifying its predictors.
The National Trauma Database (2018-2021) was queried for pediatric patients (≤18 years) with renal injury, identified via AIS codes aligned with the AAST kidney injury grading system. Urological surgical procedures were identified via ICD-10 Procedure Codes. Patients were categorized into immediate surgical management (within 4 h), conservative management (no surgery), and failed conservative management (surgery after 4 h). Demographics, injury characteristics, and clinical data were analyzed using descriptive and univariate statistical analyses (Wilcoxon Rank Sum, Chi-square, Odds Ratios).
Of 7266 pediatric renal trauma patients, most were white (63.4 %) males (69.1 %), aged 12-18 (76.6 %), suffering from unintentional blunt trauma (86.9 %). Most (n = 6610, 95 %) received conservative management; however, 4.5 % (n = 298) failed. Common surgical interventions included ureteral stent placement (n = 200, 59 %), renal IR procedures (n = 44, 13 %), and nephrectomy (n = 33, 9.7 %). Nephrectomy rates at low AAST kidney injury grades (I-II) were higher with upfront surgical management (n = 7, 3.5 %) than with failed conservative management (n = 0). Predictors of failed conservative management included higher Injury Severity Score (ISS) and higher AAST kidney injury grades (III-V) (p < 0.05).
Conservative management failed in 4.5 % of paediatric renal trauma cases, associated with higher AAST kidney injury grade and ISS. Upfront surgical management correlated with a higher nephrectomy rate at lower injury grades compared to failed conservative management. Refinement of pediatric trauma protocols is needed for optimal care.
III.
本研究旨在评估儿童肾外伤的当代管理策略，重点关注保守治疗的失败情况并确定其预测因素。
通过查询国家创伤数据库（2018 - 2021年），筛选出年龄≤18岁的肾损伤儿童患者，这些患者通过与美国创伤外科学会（AAST）肾损伤分级系统一致的AIS编码进行识别。泌尿外科手术操作通过ICD - 10手术编码进行识别。患者被分为即刻手术治疗组（4小时内）、保守治疗组（未进行手术）和保守治疗失败组（4小时后进行手术）。使用描述性和单变量统计分析（Wilcoxon秩和检验、卡方检验、优势比）对人口统计学、损伤特征和临床数据进行分析。
在7266例儿童肾外伤患者中，大多数为白人（63.4%）男性（69.1%），年龄在12 - 18岁之间（76.6%），遭受非故意伤害（86.9%）。大多数患者（n = 6610，95%）接受了保守治疗；然而，4.5%（n = 298）治疗失败。常见的手术干预措施包括输尿管支架置入术（n = 200，59%）、肾介入放射学操作（n = 44，13%）和肾切除术（n = 33，9.7%）。在AAST肾损伤低分级（I - II级）时，早期手术治疗组的肾切除率（n = 7，3.5%）高于保守治疗失败组（n = 0）。保守治疗失败的预测因素包括较高的损伤严重度评分（ISS）和较高的AAST肾损伤分级（III - V级）（p < 0.05）。
4.5%的儿童肾外伤病例保守治疗失败，这与较高的AAST肾损伤分级和ISS相关。与保守治疗失败相比，早期手术治疗在较低损伤分级时肾切除率更高。为实现最佳治疗效果，需要完善儿童创伤治疗方案。
III级
