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Urine Leaks in Children Sustaining Blunt Renal Trauma.
Journal of Trauma and Acute Care Surgery 2022 January 5
BACKGROUND: Few consensus statements exist to guide the timely diagnosis and management of urine leaks in children sustaining BRT (blunt renal trauma). The aims of this study were to characterize kidney injuries among children who sustain BRT, evaluate risk factors for urine leaks, and describe the negative impact of urinoma on patient outcomes and resource consumption.
METHODS: A retrospective review was performed of 347 patients, aged <19 years, who presented with BRT to a single ACS-verified Level I Pediatric Trauma Center between 2005-2020. Frequency of and risk factors for urine leak after BRT were evaluated, and impact on patient outcomes and resource utilization were analyzed.
RESULTS: In total, forty-four (12.7%) patients developed urine leaks, which exclusively presented among injury grades 3 (n = 5; 11.4%), 4 (n = 27; 61.4%), and 5 (n = 12; 27.3%). A minority of urine leaks (n = 20; 45.5%) were discovered on presenting CT scan but all within 3 days. Kidney-specific operative procedures (nephrectomy, cystoscopy with J/ureteral stent, percutaneous nephrostomy) were more common among urine leak patients (n = 17; 38.6%) compared with patients without urine leaks (n = 3; 1.0%; p = 0.001). Patients with urine leak had more frequent febrile episodes during hospital stay (n = 24; 54.5%; p = 0.001) and showed increased overall 90-day readmission rates (n = 14; 33.3%; p < 0.001). Independent risk factors that associated with urine leak were higher grade (OR 7.9, 95% CI 2.6-24.3; p < 0.001), upper-lateral quadrant injuries (OR 2.9, 95% CI, 1.2-7.1; p = 0.02 and isolated BRT (OR 2.6, 95% CI, 1.0-6.5; p = 0.04).
CONCLUSIONS: In a large cohort of children sustaining BRT, urine leaks result in considerable morbidity, including more febrile episodes, greater 90-day readmission rates, and increased operative or image-guided procedures. This study is the first to examine the relationship between kidney quadrant injury and urine leaks. Higher grade (4-5) injury, upper lateral quadrant location, and isolated BRT were independently predictive of urine leaks.
LEVEL OF EVIDENCE: III.
STUDY DESIGN: Care Management.
METHODS: A retrospective review was performed of 347 patients, aged <19 years, who presented with BRT to a single ACS-verified Level I Pediatric Trauma Center between 2005-2020. Frequency of and risk factors for urine leak after BRT were evaluated, and impact on patient outcomes and resource utilization were analyzed.
RESULTS: In total, forty-four (12.7%) patients developed urine leaks, which exclusively presented among injury grades 3 (n = 5; 11.4%), 4 (n = 27; 61.4%), and 5 (n = 12; 27.3%). A minority of urine leaks (n = 20; 45.5%) were discovered on presenting CT scan but all within 3 days. Kidney-specific operative procedures (nephrectomy, cystoscopy with J/ureteral stent, percutaneous nephrostomy) were more common among urine leak patients (n = 17; 38.6%) compared with patients without urine leaks (n = 3; 1.0%; p = 0.001). Patients with urine leak had more frequent febrile episodes during hospital stay (n = 24; 54.5%; p = 0.001) and showed increased overall 90-day readmission rates (n = 14; 33.3%; p < 0.001). Independent risk factors that associated with urine leak were higher grade (OR 7.9, 95% CI 2.6-24.3; p < 0.001), upper-lateral quadrant injuries (OR 2.9, 95% CI, 1.2-7.1; p = 0.02 and isolated BRT (OR 2.6, 95% CI, 1.0-6.5; p = 0.04).
CONCLUSIONS: In a large cohort of children sustaining BRT, urine leaks result in considerable morbidity, including more febrile episodes, greater 90-day readmission rates, and increased operative or image-guided procedures. This study is the first to examine the relationship between kidney quadrant injury and urine leaks. Higher grade (4-5) injury, upper lateral quadrant location, and isolated BRT were independently predictive of urine leaks.
LEVEL OF EVIDENCE: III.
STUDY DESIGN: Care Management.
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