The Contemporary Management of Pediatric Renal Trauma: A Retrospective 10-Year Analysis of the National Trauma Data Bank

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PURPOSE: 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 Data Bank. MATERIALS AND METHODS: We evaluated pediatric renal injuries in the National Trauma Databank 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 of 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 nonoperatively, 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%) patients died, of whom 660 had associated nonkidney injuries. CONCLUSIONS: Almost all cases of low-grade pediatric renal trauma can be managed expectantly. In contrast 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.

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