Evolving Mechanisms of Injury and

Management of Pediatric Blunt Renal

Trauma20 Years of Experience
Dangle PP, Fuller TW, Gaines B et al

Introduction
The kidney the most commonly injured solid organ
pediatric blunt abdominal trauma Children are at
increased risk for renal injury
anatomical reasons = large relative size of the kidney
smaller amounts of perirenal fat
less ossified thoracic rib cage increased compression

especially during rapid deceleration events

Introduction
Identifying evolving mechanisms of injury and outcomes
ensure that at-risk children can be readily identified
at presentation and primary prevention

Material and Methods

This prospectively maintained trauma database from The
Pennsylvania Trauma System Foundation
The database was reviewed for renal traumas from 1993 to
2013.
In the study period, 354 patients that sustained renal
trauma were identified
228 of the patients had adequate imaging to adequately
grade their renal injuries.
Patients with complete computed tomography imaging and
the grading per radiologist are included in the analysis.

Material and Methods

Patient demographics, grade of renal injury were colected
as described by the American Association for the Surgery of:
Trauma Renal Injury Scale
mechanism of injury need for surgical intervention and outcome
multiple trauma severity ratings including the Injury Severity Score
(ISS)
Trauma and Injury Severity Score

many individual etiologies were grouped under broad

categories such as sports, fall, etc.

Material and Methods

The mean and standard deviation are reported for
continuous variables
Simple percentages are used for categorical and
dichotomous variables
For analysis, patients were divided into 3 groups by age:
1-6, 7-11, and 12 years.

RESULT

2. Mechanism of renal injury

Fall

Sport

Pedestrian vs
MVC

MVC

ATV

Bike

Ski-sled

other

Total (%)

47 (20.6)

26 (11.4)

14 (6.1)

29 (12.7)

43 (18,9)

39 (17,1)

15 (6.6)

15 (6,6)

Mean grade
(SD)

3.0 + 1.16

2.8 + 1.31

2.4 + 1.27

2.1 + 1.03

2.6 + 1.27

2.6 + 1.25

2.7 + 1.37

2.6 + 1.18

Mean ISS

15.0 + 7.3

10.8 + 5.2

30.3 + 15.2

22.4 + 17.0

19.4 + 11.6

15.2 + 9.6

15.4 + 10.4

13.8 + 9.7

3. management
Majority of renal trauma were managed non operatively
Operative intervention only occurred in less cases

Operative Intervention
Grade
I

Stent
0

Nephrostomy
0

Nephrectomy
0

Pyeloplasty
0

II

III

IV

Total

10

Conclusion
Most blunt pediatric renal injuries are low grade (I-III)
and are likely to be sustained by male patients over the
age of 6 years.
Based on data over a period of 20 years, nearly all
pediatric renal injuries can be managed nonoperatively.
Motorized recreational vehiclerelated trauma increased
in incidence over the study period despite
recommendations against the use of motorized
recreational vehicle in the pediatric population.
Improvements in parental counseling may help in
reducing trauma from ATV use.