PittsburghV1, Main, Exploration, bibRecord, 004D81

Timing and Predictors for Urinary Drainage in Children with Expectantly Managed Grade IV Renal Trauma

Identifieur interne : 004D81 ( Main/Exploration ); précédent : 004D80; suivant : 004D82

Timing and Predictors for Urinary Drainage in Children with Expectantly Managed Grade IV Renal Trauma

Auteurs : Jeremy N. Reese [États-Unis] ; Janelle A. Fox [États-Unis] ; Glenn M. Jr Cannon [États-Unis] ; Michael C. Ostt [États-Unis] ; Richard A. Santucci [États-Unis]

Source :

The Journal of urology [ 0022-5347 ] ; 2014.

RBID : Pascal:14-0198922

Descripteurs français

Pascal (Inist)
- Traumatisme du rein, Timing, Pronostic, Facteur prédictif, Urine, Dérivation, Drainage, Enfant, Grade histologique, Rein, Pédiatrie, Plaie, Blessure, Lésion, Néphrologie, Urologie, Traitement.
Wicri :
- topic : Drainage, Enfant, Pédiatrie.

English descriptors

KwdEn :
- Bypass, Child, Drainage, Histological grading, Injury, Kidney, Kidney traumatism, Lesion, Nephrology, Pediatrics, Predictive factor, Prognosis, Timing, Treatment, Urine, Urology, Wound.

Abstract

Purpose: We determined which children sustaining blunt grade IV renal trauma are at greatest risk for failing nonoperative management and in what time frame they will likely present. Materials and Methods: We retrospectively reviewed children presenting with nonvascular grade IV blunt renal trauma between 2003 and 2012. We compared characteristics on computerized tomography, reasons for intervention, type and timing of surgery, length of hospital stay and need for readmission between children undergoing early intervention (less than 72 hours after admission) and those managed conservatively (with any subsequent intervention undertaken more than 72 hours after admission). Results: A total of 26 children were identified with nonvascular grade IV blunt renal trauma. Conservative management was attempted in 16 cases (62%). Seven of these patients (44%) required intervention (ureteral stent and/or percutaneous drain placement), with a mean time to intervention of 11 days. Collecting system clot and larger urinoma (1.45 cm in cases with successful and 4.29 cm in those with failed conservative management) significantly predicted failure of conservative management (p <0.05). Presence of dissociated renal fragments (57% vs 11%) and interpolar contrast extravasation (57% vs 0%) were increased in the early intervention group compared to the conservatively managed group (p >0.05), as was rehospitalization (43% vs 0%), mean length of stay (7.9 vs 5.4 days) and transfusion (14% vs 0%, p >0.05). Conclusions: Collecting system hematoma and urinoma size significantly predicted failure of conservative management, with a mean time to intervention of 11 days. Children with failed conservative management had a greater incidence of dissociated renal fragments and interpolar extravasation. Early identification of these patients may decrease hospital readmissions, length of stay and prolonged morbidity.

Affiliations:

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Le document en format XML

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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Timing and Predictors for Urinary Drainage in Children with Expectantly Managed Grade IV Renal Trauma</title>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Bypass</term>
<term>Child</term>
<term>Drainage</term>
<term>Histological grading</term>
<term>Injury</term>
<term>Kidney</term>
<term>Kidney traumatism</term>
<term>Lesion</term>
<term>Nephrology</term>
<term>Pediatrics</term>
<term>Predictive factor</term>
<term>Prognosis</term>
<term>Timing</term>
<term>Treatment</term>
<term>Urine</term>
<term>Urology</term>
<term>Wound</term>
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<keywords scheme="Pascal" xml:lang="fr"><term>Traumatisme du rein</term>
<term>Timing</term>
<term>Pronostic</term>
<term>Facteur prédictif</term>
<term>Urine</term>
<term>Dérivation</term>
<term>Drainage</term>
<term>Enfant</term>
<term>Grade histologique</term>
<term>Rein</term>
<term>Pédiatrie</term>
<term>Plaie</term>
<term>Blessure</term>
<term>Lésion</term>
<term>Néphrologie</term>
<term>Urologie</term>
<term>Traitement</term>
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<keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Drainage</term>
<term>Enfant</term>
<term>Pédiatrie</term>
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<front><div type="abstract" xml:lang="en">Purpose: We determined which children sustaining blunt grade IV renal trauma are at greatest risk for failing nonoperative management and in what time frame they will likely present. Materials and Methods: We retrospectively reviewed children presenting with nonvascular grade IV blunt renal trauma between 2003 and 2012. We compared characteristics on computerized tomography, reasons for intervention, type and timing of surgery, length of hospital stay and need for readmission between children undergoing early intervention (less than 72 hours after admission) and those managed conservatively (with any subsequent intervention undertaken more than 72 hours after admission). Results: A total of 26 children were identified with nonvascular grade IV blunt renal trauma. Conservative management was attempted in 16 cases (62%). Seven of these patients (44%) required intervention (ureteral stent and/or percutaneous drain placement), with a mean time to intervention of 11 days. Collecting system clot and larger urinoma (1.45 cm in cases with successful and 4.29 cm in those with failed conservative management) significantly predicted failure of conservative management (p <0.05). Presence of dissociated renal fragments (57% vs 11%) and interpolar contrast extravasation (57% vs 0%) were increased in the early intervention group compared to the conservatively managed group (p >0.05), as was rehospitalization (43% vs 0%), mean length of stay (7.9 vs 5.4 days) and transfusion (14% vs 0%, p >0.05). Conclusions: Collecting system hematoma and urinoma size significantly predicted failure of conservative management, with a mean time to intervention of 11 days. Children with failed conservative management had a greater incidence of dissociated renal fragments and interpolar extravasation. Early identification of these patients may decrease hospital readmissions, length of stay and prolonged morbidity.</div>
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Timing and Predictors for Urinary Drainage in Children with Expectantly Managed Grade IV Renal Trauma

Timing and Predictors for Urinary Drainage in Children with Expectantly Managed Grade IV Renal Trauma

Source :

Descripteurs français

English descriptors

Abstract

Links toward previous steps (curation, corpus...)

Le document en format XML

Pour manipuler ce document sous Unix (Dilib)

Pour mettre un lien sur cette page dans le réseau Wicri