Hwang, Catalina K, Matta, Rano, Woolstenhulme, Jonathan, Britt, Alexandra K, Schaeffer, Anthony J, Zakaluzny, Scott A, Kleber, Kara Teresa, Sheikali, Adam, Flynn-O'Brien, Katherine T, Sandilos, Georgianna, Shimonovich, Shachar, Fox, Nicole, Hess, Alexis B, Zeller, Kristen A, Koberlein, George C, Levy, Brittany E, Draus, John M, Sacks, Marla, Chen, Catherine, Luo-Owen, Xian, Stephens, Jacob Robert, Shah, Mit, Burks, Frank, Moses, Rachel A, Rezaee, Michael E, Vemulakonda, Vijaya M, Halstead, N Valeska, LaCouture, Hunter M, Nabavizadeh, Behnam, Copp, Hillary, Breyer, Benjamin, Schwartz, Ian, Feia, Kendall, Pagliara, Travis, Shi, Jennifer, Neuville, Paul, and Hagedorn, Judith C
BackgroundPediatric 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.MethodsRetrospective 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.ResultsIn 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%.ConclusionThe 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 evidencePrognostic and Epidemiological; Level IV.