Impact of trauma center designation in pediatric renal trauma: National Trauma Data Bank analysis.

Summary Introduction The pediatric kidney is the most common urinary tract organ injured in blunt abdominal trauma. Trauma care in the United States has been established into a hierarchical system verified by the American College of Surgeons (ACS). Literature evaluating management of pediatric renal trauma across trauma tier designations is scarce. Objective To examine the differences in the management and outcomes of renal trauma in the pediatric population based on trauma level designation across the United States. Study design We performed a review of the ACS - National Trauma Data Bank database. Pediatric patients (age 0–18 years) who were treated for renal injury between years 2011–2016 were identified. Our primary outcome was the difference in any complication rate amongst Level I versus Non-Level I trauma centers. Management strategies were evaluated as secondary outcomes. Propensity score matching (PSM) was utilized to adjust for baseline differences between cohorts. Multivariable regression analysis was performed to determine the independent effects of individual factors on complications, operative intervention, minimally invasive procedure, and blood transfusions. Results Overall, 12,097 pediatric patients were diagnosed with renal trauma between 2011 and 2016 using target ICD-9 and AAST codes. After PSM, there was a total of 1623 subjects withing each group. No difference was identified between groups for occurrence on any complication [105 (6.5%) vs 114 (7.0%), p = 0.576. There were no differences in the rate of minimally invasive interventions [67 (4.1%) vs 48 (3.0%), p = 0.087], operative intervention [58 (3.6%) vs 68 (4.2%), p = 0.413], or nephrectomy [42 (2.6%) vs 47 (2.9%), p = 0.667] between Level I and Non-Level I trauma designations, respectively. Length of stay was longer in the Level I cohort compared to Non-Level I (days (SD)) [6.9 (8.8) vs 6.2 (7.9), p = 0.024. When specifically looking at risk factors associated with operative intervention, higher renal injury grade and injury severity score were highly correlated, whereas, trauma level designation was not found to be predictive for more aggressive management. Discussion & conclusion Our results corroborate with previous literature that renal injury grade and injury severity score are strong predictors of morbidity, invasive management, and complications. Pediatric renal trauma was managed similarly across trauma center designations, with the rate of complication and intervention more prevalent in patients with high grade renal injuries and concomitant injuries. Further studies are necessary to identify patients who will benefit most from transfer to a level I center. Summary Table . Summary of Outcomes between Level I and Non-Level I Trauma Tier Designation Pre-PSM∗ Post-PSM∗ Level I Non-Level I P value Level I Non-Level I P value N 2710 1631 1623 1623 LOS∗∗ (days): mean (SD) 7.5 (9.8) 6.2 (7.9) 6.9 (8.8) 6.2 (7.9) 0.024 Any Complication (%) 0.1 (0.3) 0.1 (0.2) 0.107 105 (6.5) 114 (7.0) 0.576 Blood Transfusion (%) 205 (12.6) 205 (12.6) 0.004 235 (14.5) 205 (12.6) 0.137 Minimal-Invasive Intervention (%) 109 (4.0) 48 (2.9) 0.078 67 (4.1) 48 (3.0) 0.087 Operative Intervention (%) 119 (4.4) 68 (4.2) 0.786 58 (3.6) 68 (4.2) 0.413 Nephrectomy (%) 83 (3.1) 47 (2.9) 0.805 42 (2.6) 47 (2.9) 0.667 ∗Propensity Score Matching. ∗∗Length of Stay. Bolded P values signify clinical significance as defined by P