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BMC Urology

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Open Access 01-12-2023 | Nephrectomy | Research

Factors affecting and effects of hemodynamic stability of pediatric patients with grades 3–5 renal trauma: a prospective non-randomized comparative study

Authors: Rabea Ahmed Gadelkareem, Ahmed Hamdan, Amr Abou Faddan, Hisham Mokhtar Hammouda, Mohamed Ali Zarzour

Published in: BMC Urology | Issue 1/2023

Abstract

Background

Researches on the effect of hemodynamic stabilization on the implantation of conservative management for pediatric high-grade renal traumas are lacking. We aimed to assess the effect of maintaining the initial hemodynamic stability of pediatric patients with grades 3–5 renal trauma on the implementation of the conservative treatment and identify its defining factors.

Methods

A prospective study was performed on pediatric patients with grade 3–5 renal traumas who presented to our hospital during July 2020–June 2022. Hemodynamically stable patients were compared with the unstable patients for clinical characteristics, hemodynamic stabilization, and rates of success of conservative treatment.

Results

Forty-three patients were studied, including 26 boys and 17 girls. Of them, 28 (65.1%) patients presented with hemodynamic stability and 15 (34.9%) patients were unstable. Overall, 32 (74.4%) patients achieved and/or maintained hemodynamic stability for conservative management. There was a significant difference in blood pressure level at presentation (p < 0.001). The improvement of the hemodynamic parameters was significant per group and, in comparison (p < 0.001). The size of hematoma was significantly smaller in patients with hemodynamic stability (p = 0.023). Despite the longer (p = 0.033) hospital stay with conservative management, the rates of blood transfusion (p = 0.597) and hospital stay (p = 0.785) were not significantly different between both groups. The rates of nephrectomy and mortality were 14% and 0%, respectively. Blood pressure was independently associated with the achievement of maintained hemodynamic stability for conservative management (p = 0.022).

Conclusions

Hemodynamic stabilization seems to be effective and safe for implementing successful conservative management for pediatric patients with high-grade renal traumas. Blood pressure was the only independent factor of maintaining hemodynamic stability.

Mahran A, Fernstrum A, Swindle M, Mishra K, Bukavina L, Raina R, Narayanamurthy V, et al. Impact of trauma center designation in pediatric renal trauma: National Trauma Data Bank analysis. J Pediatr Urol. 2020;16:658. .e1-658.e9.CrossRef

Singer G, Arneitz C, Tschauner S, Castellani C, Till H. Trauma in pediatric urology. Semin Pediatr Surg. 2021;30:151085. https://doi.org/10.1016/j.sempedsurg.2021.151085.CrossRefPubMed

Wong KY, Jeeneea R, Healey A, Abernethy L, Corbett HJ, McAndrew HF, et al. Management of paediatric high-grade blunt renal trauma: a 10-year single-centre UK experience. BJU Int. 2018;121:923–7. https://doi.org/10.1111/bju.14142.CrossRefPubMed

Loggers SAI, Koedam TWA, Giannakopoulos GF, Vandewalle E, Erwteman M, Zuidema WP. Definition of hemodynamic stability in blunt trauma patients: a systematic review and assessment amongst Dutch trauma team members. Eur J Trauma Emerg Surg. 2017;43:823–33. https://doi.org/10.1007/s00068-016-0744-8.CrossRefPubMed

Rogers CG, Knight V, MacUra KJ, Ziegfeld S, Paidas CN, Mathews RI. High-grade renal injuries in children—is Conservative management possible? Urology. 2004; 64:574–99. https://doi.org/10.1016/j.urology.2004.04.069.

Bryk DJ, Zhao LC. Guideline of guidelines: a review of urological trauma guidelines. BJU Int. 2016;117:226–34. https://doi.org/10.1111/bju.13040.CrossRefPubMed

Taie MR, Gadelkareem RA, Shalaby MM, Ahmed AI. Conservative and interventional managements of grades 3–5 renal trauma: a prospective comparative study. Clin Res Urol. 2018;1:1–6.

Morey AF, Broghammer JA, Hollowell CMP, McKibben MJ, Souter L. Urotrauma Guideline 2020: AUA Guideline. J Urol. 2021;205:30–5. https://doi.org/10.1097/JU.0000000000001408.CrossRefPubMed

Redmond EJ, Kiddoo DA, Metcalfe PD. Contemporary management of pediatric high grade renal trauma: 10 year experience at a level 1 trauma centre. J Pediatr Urol. 2020;16:656.e1-656.e5. https://doi.org/10.1016/j.jpurol.2020.06.033.

10.

Eeg KR, Khoury AE, Halachmi S, Braga LH, Farhat WA, Bägli DJ, et al. Single center experience with application of the ALARA concept to serial imaging studies after blunt renal trauma in children–is ultrasound enough? J Urol. 2009;181:1834–40. https://doi.org/10.1016/j.juro.2008.12.007. discussion 1840.CrossRefPubMed

11.

Dantanarayana N, Ting F, Symons J, Evans D, Graham A. Isolated Grade 5 Renal Trauma in a hemodynamically stable patient. Urol Case Rep. 2015;4:30–2. https://doi.org/10.1016/j.eucr.2015.11.005.CrossRefPubMedPubMedCentral

12.

Hagedorn JC, Fox N, Ellison JS, Russell R, Witt CE, Zeller K, et al. Pediatric blunt renal trauma practice management guidelines: collaboration between the Eastern Association for the Surgery of Trauma and the Pediatric Trauma Society. J Trauma Acute Care Surg. 2019;86:916–25. https://doi.org/10.1097/TA.0000000000002209.CrossRefPubMed

13.

Shaikh NA, Shaikh AA, Soomro MI, Pirzado AG, Rohra KC, Mangrio RH. Evaluation and management of renal injuries: our experience at Urology Department CMC/SMBBMU Larkana, Pakistan. Rawal Med J. 2022;47:145–7.

14.

Ishida Y, Tyroch AH, Emami N, McLean SF. Characteristics and management of Blunt Renal Injury in Children. J Emerg Trauma Shock. 2017;10:140–5. https://doi.org/10.4103/JETS.JETS_93_16.CrossRefPubMedPubMedCentral

15.

Ammor A, Haissoufi KE, Karrouchi M, Nasri S, Skiker I, Benhaddou H. Blunt renal trauma in children: the experience of Mohammed VI University Hospital of Oujda in Morocco between 2015 and 2021. Pan Afr Med J. 2022;41:347. https://doi.org/10.11604/pamj.2022.41.347.31945.CrossRefPubMedPubMedCentral

16.

Yeung LL, Brandes SB. Contemporary management of renal trauma: differences between urologists and trauma surgeons. J Trauma Acute Care Surg. 2012;72:68–75. https://doi.org/10.1097/TA.0b013e31823e29f6. discussion 75 – 7.CrossRefPubMed

17.

Nash PA, Bruce JE, McAninch JW. (1995) Nephrectomy for traumatic renal injuries. J Urol. 1995;153:609–611. https://doi.org/10.1097/00005392-199503000-00012.

18.

Okur MH, Arslan S, Aydogdu B, Arslan MS, Goya C, Zeytun H, et al. Management of high-grade renal injury in children. Eur J Trauma Emerg Surg. 2017;43:99–104. https://doi.org/10.1007/s00068-016-0636-y.CrossRefPubMed

19.

O’Brien AC, Healy GM, Rutledge N, Patil A, McCann JWJ, Cantwell CP. Conventional angiography findings in hemodynamically unstable patients with acute abdominal Hemorrhage and a negative CT bleeding study. CVIR Endovasc. 2020;3:22. https://doi.org/10.1186/s42155-020-00112-7.CrossRefPubMedPubMedCentral

20.

Wang B, Wen C, Song S, Li G, Yan Y, Cheng S, et al. Safety and efficacy of Endovascular Management of high-grade blunt renal injury. J Interv Med. 2022;5:23–7. https://doi.org/10.1016/j.jimed.2021.12.003.CrossRefPubMedPubMedCentral

Title: Factors affecting and effects of hemodynamic stability of pediatric patients with grades 3–5 renal trauma: a prospective non-randomized comparative study
Authors: Rabea Ahmed Gadelkareem
Ahmed Hamdan
Amr Abou Faddan
Hisham Mokhtar Hammouda
Mohamed Ali Zarzour
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Nephrectomy
Nephrectomy
Nephrectomy
Hematoma
Pediatrics
Published in: BMC Urology / Issue 1/2023
Electronic ISSN: 1471-2490
DOI: https://doi.org/10.1186/s12894-023-01381-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Factors affecting and effects of hemodynamic stability of pediatric patients with grades 3–5 renal trauma: a prospective non-randomized comparative study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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