The contemporary management of pediatric renal trauma: A retrospective 10-year analysis of the National Trauma Databank

BACKGROUND: Conservative management of adult renal trauma with observation or angioembolization has led to a decline in nephrectomies. In children, trauma is the leading cause of mortality, and renal injury is a frequent consequence of abdominal trauma. However, data on management and outcomes of pediatric renal trauma remain limited. We sought to describe care patterns in a contemporary 10-year period of the National Trauma Databank (NTDB). METHODS: We evaluated pediatric renal injuries in the NTDB between 2013 and 2022. Relevant injury characteristics and kidney related procedures, including interventions for bleeding and collecting system, were extracted. Injury characteristics, management patterns, and outcomes were analyzed and reported. RESULTS: Our cohort consisted of 15,138 patients with a mean age 13.7 (SD 4.2) years. Most injuries resulted from a blunt trauma (89%) and 67% were high grade. Overall, 90% of patients were managed non-operatively, including 98% of those with low-grade injuries. The most common bleeding interventions were nephrectomy (n=603, 3.9%), angioembolization (n=324, 2.1%), and surgical repair (n=204, 1.4%). The most common collecting system interventions were ureteral stent (n=606, 4%), nephrostomy tube (n=143, 0.9%), and perirenal drain (n=122, 0.8%). Overall, the proportion of those cases receiving nephrectomy was 5.8% and was stable over the years examined. Among high-grade injuries, angioembolization (n = 294) achieved 87% success in avoiding further bleeding interventions vs 81% for surgical repair (n = 180). Nephrectomy use was lower after angioembolization vs after surgical repair. A total of 662 (4.3%) died of which 660 had associated non-kidney injuries. CONCLUSIONS: Almost all cases of low grade pediatric renal trauma can be managed expectantly. In contrary to adult data in the literature, nephrectomy use did not decrease over time. In those who do receive kidney sparing bleeding interventions, angioembolization seems to achieve higher kidney salvage, however, selection bias may limit the validity of this comparison.