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Renal Trauma In Children: Mechanism Of Injury And Outcomes At A Rural Northern New England Level I Trauma
Elizabeth B Johnson, Levi A Deters, Paul A Merguerian
Dartmouth-Hitchcock Medical Center, Lebanon, NH

Objective: Blunt abdominal trauma Results in renal injury in 10% of pediatric cases. The published mechanism of injury is motor vehicle accidents(MVA) while recreational injuries are less common. No data is currently available on the mechanism of injury in a rural level I pediatric trauma center. We hypothesize that it is different.
Methods: After approval from the institutional review board, we retrospectively reviewed the medical records of 40 consecutive children with renal trauma between 2006 and 2010. Patients were stratified into two groups (under and over 16 years of age). Parameters reviewed included mechanism of injury, severity of injury, associated injuries, management and clinical outcomes.
Results: Of the 40 patients, 26/40(65%) had recreational related injury. Snow sports was the most prevalent (14/26, 53.8%). MVAs accounted for 11/40 (27.5%) of injuries. Two injuries presented with co-existing urinary tract anomalies. Of the 18 children under 16 years of age the mechanism of injury was recreational in 14/18 (77.8%). Of these, 6 (42.9%) were related to winter sports. Only 2/18(11.1%) were related to MVA. Majority of injuries were grade III, two had vascular injuries with poor or no perfusion into the kidney. All patients were managed conservatively with two patients requiring embolization for bleeding.
Conclusion: Recreational sport injuries are the major cause of blunt renal trauma at our rural Level I pediatric trauma center. Most of these injuries were managed conservatively. Due to delay in transfer to our trauma center grade V trauma with renal devascularization resulted in loss of renal function.


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