Acute Kidney Injury in Pediatric Polytrauma Patients at Assiut University Trauma Unit: A Cross-Sectional Study on Incidence and Predictive Risk Factors

Study Overview
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Brief Summary
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This study aims to investigate the true incidence and clinical presentation of post-traumatic AKI in hospitalized pediatric patients and identify the risk, and severity of AKI. The results would aid the emergency physicians in the early identification of those at risk of AKI to establish a resuscitation strategy that aims at preventing AKI

Detailed Description
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Trauma is a leading cause of morbidity and mortality throughout Africa and the leading cause of mortality worldwide for children and young adults (5-29 years of age). Organ failure, including AKI, is the third leading cause of mortality in trauma patients, after bleeding and brain injuries. Trauma patients are at risk of AKI caused by renal hypoperfusion (secondary to haemorrhagic shock), rhabdomyolysis, direct renal injury, abdominal compartment syndrome, or the nephrotoxic effects of therapies. The majority of trauma-based AKI studies worldwide have looked at critically ill adult trauma patients and these report highly variable AKI rates, ranging 1-50%. Though pediatric trauma studies on AKI are scarce, a California study suggests 13% of pediatric post-traumatic rhabdomyolysis patients experience AKI. Acute kidney injury (AKI) is described as a spectrum of abruptly compromised renal functions that result in impaired balance of fluid, electrolytes, and waste products. It is recognized as an increasingly common cause of morbidity and mortality in children. AKI is defined according to The Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines as any of the following: increase in serum creatinine by ≥0.3 mg/dL within 48 h; or increase in serum creatinine to ≥1.5 times baseline, which is known or presumed to have occurred within the prior seven days; or urine volume <0.5ml /kg/ h for 6 hr. Preventive measures for AKI are currently the mainstay of non-dialytic AKI management. They include the use of a pediatric early warning score for early detection of AKI, preparation to provide for volume resuscitation in patients with hypovolemia related oliguria, and halting the administration of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers in such patients until their volume status is stabilized. Using appropriate nephrotoxic drug doses (i.e., vancomycin and/or contrast media) to reduce harm to the kidneys. RRT is the most effective way of managing severe AKI. Peritoneal dialysis has shown as an effective adjuvant treatment for achieving a negative fluid balance, decreasing mechanical ventilation duration, and reducing electrolyte disturbances There is currently no specific effective treatment after the occurrence of established AKI Early detection and prevention of AKI is essential.

Official Title
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Incidence and Predictive Risk Factors of Acute Kidney Injury in Pediatric Polytrauma Patients Admitted to Assiut University Trauma Unit: a Cross-sectional Study

Conditions
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Acute Kidney Injury

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The present study will be conducted on pediatric patients with multiple traumas of both genders aged 2yr to 18 yr who have no previous history of kidney disease or chronic illness. Exclusion Criteria: Patients who are less than 2 years old or more than 18 years old. Direct trauma kidney or localized individual trauma children with preexisting kidney disease children with drug nephrotoxicity children underwent renal transplant children post-cardiac arrest Patients leaving the hospital on the same day or transferred to a different hospital will be excluded from this study. Patients refusing the study will be excluded.

Ages Eligible for Study
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Minimum Age: 2 Years
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of AKI in Pediatric Trauma Patients Admitted to ER | Describing the true incidence of AKI in pediatric trauma patients who are admitted to ER. a) Identification of AKI according to the KDIGO guidelines as follows: I. Increase in serum creatinine by ≥0.3 mg/dL (≥26.5 micromol/L) within 48 hours, or II. Increase in serum creatinine to ≥1.5 times baseline, which is known or presumed to have occurred within the prior seven days, or III. Urine volume <0.5 mL/kg/hour for six hours | baseline | 
| timing of AKI in pediatric trauma patients admitted to ER | time period between admission and diagnosis of AKI | baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Risk Identification of AKI in pediatric trauma patients | Identifying risk for AKI as presence of shock and/or rhabdomyolysis. Exposure to nephrotoxic drugs . | baseline | 
| mortality outcomes of AKI in pediatric trauma patients | The standardized mortality ratio represents the excess mortality and will be calculated using the observed number of lethal cases divided by the predicted number of lethal cases. The observed count will be obtained from the study data. The predicted number will be obtained by implementing the percentage of mortality risk from all the tools used. The individual values of the risk scores will be averaged to represent the study population. | Baseline |