Over the past decade, treatment of pediatric renal trauma has increasingly moved toward observation, especially for high-grade renal trauma (HGRT) in children who are hemodynamically stable. We hypothesized that, compared to historical rates, surgical intervention for pediatric HGRT has decreased but that HGRT still tends to involve more aggressive intervention than low-grade renal trauma (LGRT). A retrospective cohort study was conducted using data from the TriNetX database spanning 2012–2023, focusing on patients under 20 years old presenting with renal trauma. Injuries were classified as either LGRT (Grades I-III) or HGRT (Grades IV-V) based on the American Association for the Surgery of Trauma (AAST) grading. We analyzed initial and follow-up management strategies, imaging use, interventions within a week of trauma, and long-term outcomes, tracked from one month to five years post-injury.
Among 1,997 renal trauma patients (526 HGRT and 1,471 LGRT), ultrasound and multiphase CT scans were frequently used for initial evaluation in both groups, with HGRT patients more likely to have additional abdominal and pelvic plain films. Observation was the most common management strategy for both groups, with 95% of LGRT and 84% of HGRT patients managed this way. However, HGRT patients had higher rates of transfusion (37% vs. 26%), embolization (6% vs. 3%), exploratory laparotomy (6% vs. 3%), and nephrectomy (4% vs. 0%). Renal ultrasound was commonly used for follow-up surveillance. Rates of hypertension, chronic kidney disease (CKD), renal replacement therapy, and psychological outcomes like depression and anxiety were similar between LGRT and HGRT groups. This suggests that LGRT, while typically managed with observation, may still warrant ongoing follow-up and psychological support similar to HGRT. Our findings highlight a shift toward conservative management in HGRT, with lower surgical intervention rates and comparable long-term outcomes across trauma grades.
