Outcomes of Severe Acute Kidney Injury in Pediatric Trauma Patients; The Trauma Quality Improvement Program Database Study

Nasim Ahmed; Yen-Hong Kuo; Roy O Mathew; Arif Asif

doi:10.1016/j.jpedsurg.2023.05.013

Outcomes of Severe Acute Kidney Injury in Pediatric Trauma Patients; The Trauma Quality Improvement Program Database Study

J Pediatr Surg. 2023 Nov;58(11):2206-2211. doi: 10.1016/j.jpedsurg.2023.05.013. Epub 2023 May 23.

Authors

Nasim Ahmed¹, Yen-Hong Kuo², Roy O Mathew³, Arif Asif⁴

Affiliations

¹ Hackensack Meridian School of Medicine, Nutley, NJ, USA; Department of Surgery, Division of Trauma & Surgical Critical Care, USA. Electronic address: Nasim.Ahmed@hmhn.org.
² Office of Research Administration, Jersey Shore University Medical Center, Neptune, NJ, USA; Hackensack Meridian School of Medicine, Nutley, NJ, USA.
³ Department of Medicine, Division of Nephrology, Loma Linda VA Health Care System, Loma Linda, CA, USA.
⁴ Hackensack Meridian School of Medicine, Nutley, NJ, USA; Department of Medicine, Jersey Shore University Medical Center, USA.

PMID: 37353390
DOI: 10.1016/j.jpedsurg.2023.05.013

Abstract

Introduction: Acute kidney injury (AKI) has been associated with higher mortality and morbidity in trauma victims. There is a paucity of information regarding the outcomes of severe AKI (sAKI) in pediatric trauma patients. Therefore, the trauma quality improvement program database (TQIP) was used to assess that hypothesis sAKI will be associated with higher mortality among pediatric trauma patients.

Methods: The TQIP database was accessed for the study. Patients aged <18 years old admitted to the hospital after sustaining injury were included in the study. Demographics, injury severity score (ISS) and Glasgow coma scale (GCS) score, other body regions injuries, and available comorbidities were included in the study. Propensity score matching analysis was performed to compare the two groups, sAKI vs. no sAKI on patients' characteristics and outcomes. All p values are two-sided. A p-value <0.05 is considered statistically significant.

Results: Out of 139,832 patients who qualified for the study, 106 (0.1%) patients suffered from sAKI. Pair-matched analysis showed no significant difference between the groups, sAKI, and no sAKI, regarding the in-hospital mortality (14.3% vs. 12.4%, P = 0.838). There was a prolonged hospital length of stay in the sAKI group when compared to the no sAKI group, (27 days [21-33] vs. 10 [9-14], P < 0.001). There was a higher incidence of deep vein thrombosis (DVT) (12.4% vs. 2.9%, P = 0.024) in the sAKI group as well.

Conclusion: The sAKI patients stayed in the hospital approximately three times longer and had a 4-fold increase in the occurrence of DVT. No significant difference was found between the groups in in-hospital mortality.

Type of study: Retrospective cohort study.

Keywords: Acute kidney injury; Outcomes; Pediatric trauma.