Follow-up patterns and post-injury physical activity recommendations in pediatric high-grade renal trauma: A multicenter, retrospective analysis from the traumatic renal injury collaborative in kids (TRICK) consortium.

Abstract

Introduction: There is little consensus regarding optimal timing of follow-up or recommendations for duration of abstinence from sports following traumatic renal injuries.

Objective: We aimed to characterize patterns of follow-up and post-trauma activity recommendations following high-grade pediatric renal trauma (HGRT) and provide tentative guidelines based on these findings.

Study design: We reviewed all pediatric patients ≤18 years-old presenting to five level-1 pediatric trauma centers with AAST (American Association for the Surgery of Trauma) HGRT (grades III-V) from 2007 to 2020. Patient follow-up patterns and recommendations regarding time to return to sports were assessed from hospital records.

Results: 310 patients were included in final analysis: 135 grade III, 143 grade IV, and 32 grade V renal injuries. Higher injury severity score (ISS) was associated with higher renal trauma grade (p = 0.003). After hospital discharge, 41.94 % of the cohort had documented follow-up with urology and 37.42 % followed up with trauma surgery. A majority, 66.45 % (206/310), received recommendations regarding time to return to physical activity, with a median recommendation of 6.0 weeks [0,24]. Significant differences were seen between trauma centers independent of ISS or concomitant visceral injuries (recommendation given, p = 0.003; specialty providing recommendation, p < 0.001; and median time to resumption of physical activity, p < 0.001). Grade V HGRT had rates of post-trauma hypertension approaching 10 %.

Discussion: In this large, multicenter high-grade pediatric renal trauma cohort, less than half of patients followed up with urology after the hospital stay. Additionally, only 66.45 % of patients received recommendations regarding abstinence from sports activities, and with highly variable timeframes between pediatric trauma institutions but not between the severity of renal trauma. There were no readmissions after 5 weeks of healing. Based on these findings, the authors tentatively recommend 6-8 weeks for return to activity with at least one of the following: 1) patient is asymptomatic and 2) confirmed healing on follow-up imaging.

Conclusion: Even at level-1 pediatric trauma centers, follow-up after discharge and return to sports instructions for HGRT in the pediatric population was limited and highly variable between institutions. These findings suggest the need for better standardization of follow-up and post-trauma activity recommendations and suggest patient populations, specifically Grade V HGRT, who may benefit from resources for improved follow-up.