背景:意外伤害是儿童死亡和发病的主要原因。对理想没有共识,小儿肾损伤(PRT)的离散处理。因此,管理协议往往是特定于机构的。
目的:本研究旨在描述农村一级创伤中心的PRT特征,并随后制定标准化方案。
方法:对2009年至2019年在农村一级创伤中心前瞻性维护的PRT数据库进行了回顾性审查。损伤的特点是肾损伤分级,相关的多器官参与和干预的必要性。评估了从地区医院转移患者的收益以及住院时间和费用。
结果:对250例诊断为肾损伤的患者中50例<18岁的患者进行分析。其中,大多数(32/50,64%)有低级(I-III级)损伤.保守管理在所有低度伤害中都是成功的。在18个高级PRT中,10(55.6%)需要干预,转移前的一个。在低度创伤患者中,23/32(72%)是从外部设施转移的。共有13例(26%)孤立性低级别肾损伤患者从地区医院转移。都是孤立的,转移的低级别肾损伤在转移前有诊断性影像学检查,且不需要侵入性干预.肾损伤的介入治疗与保守治疗的中位LOS[7(IQR=4-16.5)和4(IQR=2-6)天相关,p=0.019)]和增加的总成本中位数为57,986美元,而不是保守管理18,042美元(p=0.002)。
结论:大多数PRT,特别是低等级的,可以保守管理。患有低度创伤的儿童中有很大一部分被不必要地转移到更高级别的中心。十年来,我们机构对小儿肾外伤的审查使我们能够制定一项机构协议,我们认为该协议可以安全有效地进行患者监测。
结论:孤立,低等级PRT可以在地区医院进行保守管理,而无需转移到1级创伤中心。高度受伤的儿童应密切监测,更有可能需要侵入性干预。制定PRT协议将有助于安全地对该人群进行分类,并确定可能从转移到三级护理中心中受益的人群。
Unintentional injury is a leading cause of mortality and morbidity in children. There is no consensus on the ideal, discrete management of pediatric renal trauma (PRT). Therefore, management protocols tend to be institution-specific.
This study aimed to characterize PRT at a rural level-1 trauma center and subsequently develop a standardized protocol.
A retrospective review of a prospectively maintained database of PRT at a rural level 1 trauma center between 2009 and 2019 was conducted. Injuries were characterized regarding renal trauma grade, associated multi-organ involvement and the need for intervention. The benefit of patient transfer from regional hospitals and length and cost of stay were evaluated.
Of 250 patients admitted with renal trauma diagnosis 50 patients <18 years were analyzed. Of those, the majority (32/50, 64%) had low-grade (grade I-III) injuries. Conservative management was successful in all low-grade injuries. Of 18 high-grade PRT, 10 (55.6%) required intervention, one prior to transfer. Among patients with low-grade trauma, 23/32 (72%) were transferred from an outside facility. A total of 13 (26%) patients with isolated low-grade renal trauma were transferred from regional hospitals. All isolated, transferred low-grade renal trauma had diagnostic imaging before transfer and none required invasive intervention. Interventional management of renal injury was associated with a longer median LOS [7 (IQR = 4-16.5) vs 4 (IQR = 2-6) days for conservative management, p = 0.019)] and an increased median total cost of $57,986 vs. $18,042 for conservative management (p = 0.002).
The majority of PRT, particularly low-grade, can be managed conservatively. A significant proportion of children with low-grade trauma are unnecessarily transferred to higher level centers. Review of pediatric renal trauma at our institution over a decade has allowed us to develop an institutional protocol which we believe allows for safe and effective patient monitoring.
Isolated, low-grade PRT can be managed conservatively at regional hospitals without needing transfer to a level 1 trauma center. Children with high-grade injuries should be closely monitored and are more likely to need invasive intervention. Development of a PRT protocol will help to safely triage this population and identify those who may benefit from transfer to a tertiary care center.