title: Evolving Mechanisms of Injury and Management of Pediatric Blunt Renal Trauma--20 Years of Experience.
abstract: OBJECTIVE
  To review 20 years of a prospectively maintained trauma database to identify changing trends in mechanisms of renal injury, demographics, and management outcomes.
  
  
  METHODS
  Following the approval from the institutional review board, a prospectively maintained trauma database was reviewed for renal trauma patient demographics, management, and mechanisms of injury. Data were reviewed first for the entire cohort and then incrementally to identify mechanisms of injury associated with increasing frequency or grade of injury.
  
  
  RESULTS
  A total of 228 graded renal injuries were identified from 1993 to 2013. The majority of renal injuries occurred in males (77.2%) >6 years of age (85.1%). Low grade (I-III) injuries were more common (70.6%). The most frequent mechanisms of injury identified were falls, recreational motor vehicle (RMV) accidents, bike accidents, motor vehicle collisions, and sports accidents, in descending order of frequency. RMV-related injuries have become frequent with time despite recommendations against use in the pediatric age population. Surgical intervention was rarely necessary. Over the 20 year study period, 5 nephrectomies (1.4%) were required, whereas 10 endoscopic interventions or percutaneous drainage procedures were needed (2.4%).
  
  
  CONCLUSIONS
  The majority of blunt pediatric renal injuries are low grade and can be managed nonoperatively. Nephrectomy is rarely required but is indicated for hemodynamic instability refractory to resuscitation. Pediatric blunt renal trauma secondary to RMV use is increasing despite recommendations against their use in the pediatric population.
authors.affiliation: Division of Pediatric Urology, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: pankaj.dangle@chp.edu.
authors.forename: Pankaj P
authors.initials: PP
authors.lastname: Dangle
authors.affiliation: Division of Pediatric Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Fuller
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Gaines
authors.affiliation: Division of Pediatric Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Cannon
authors.affiliation: Division of Pediatric Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Francis X
authors.initials: FX
authors.lastname: Schneck
authors.affiliation: Division of Pediatric Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Heidi A
authors.initials: HA
authors.lastname: Stephany
authors.affiliation: Division of Pediatric Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Ost
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D007668:Kidney / Q000293:injuries*; D008297:Male; D009392:Nephrectomy; D011446:Prospective Studies; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000209:etiology* / Q000628:therapy*; D055815:Young Adult