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Background <p>Acute Kidney Injury (AKI) increases morbidity and mortality risk, yet data in pediatric trauma are limited. This study evaluated the incidence of Kidney Disease: Improving Global Outcomes (KDIGO) stage 3 AKI, kidney replacement therapy (KRT) use, and associated risk factors in pediatric trauma patients.</p> Methods <p>Pediatric patients (&lt; 18&#xa0;years) in the Trauma Quality Improvement Program (TQIP) database from 2017–2023 were analyzed for stage 3 AKI. Multivariable logistic regression (MVLR) identified associations between AKI and adverse outcomes, adjusting for confounders. Serious injury was defined as an abbreviated injury scale (AIS) ≥ 3 per body region.</p> Results <p>Among 867,467 pediatric trauma cases, 510 developed stage 3 AKI. Compared to children without stage 3 AKI, affected children had higher median composite injury severity scores (4 versus 26, <i>p</i> &lt; 0.001) and lower survival (98% versus 69%, <i>p</i> &lt; 0.001). In the MVLR model, older children, male sex (OR 1.20, 95%&#xa0;CI: 0.97–1.49), serious injury to the head/neck (3.48, 2.84–4.28), thorax (2.50, 2.00–3.11), abdomen (5.90, 4.79–7.28), extremities (2.26, 1.84–2.79), and skin (3.16, 2.14–4.68), in-hospital cardiac arrest (8.18, 6.24–10.72), pulmonary embolism (3.88, 1.97–7.66), sepsis (36.32, 23.83–55.37), ventilator-associated pneumonia (3.10, 1.96–4.91), acute respiratory distress syndrome (1.73, 1.03–2.89), and extracorporeal support (9.34, 5.51–15.85) were associated with stage 3 AKI. Patients with urologic injuries had higher rates of stage 3 AKI (0.6% vs. 0.046%, <i>p</i> = 0.0001). KRT was used in 20% of stage 3 AKI cases.</p> Conclusions <p>Stage 3 AKI was rare in pediatric trauma but strongly linked to abdominal, head/neck, and urologic injuries. Mortality was markedly increased when stage 3 AKI occurred.</p>

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Incidence and outcomes of stage 3 acute kidney injury in the setting of pediatric trauma: a trauma quality improvement program analysis

  • 期刊论文

  • 发表日期：

    2026年1月29日

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  • Courtney M. Giannini,
  • Austin McCuistion,
  • Erin Stenson,
  • Weiwen Vivian Shih,
  • Shannon N. Acker,
  • Steven G. Schauer

摘要

Background

Acute Kidney Injury (AKI) increases morbidity and mortality risk, yet data in pediatric trauma are limited. This study evaluated the incidence of Kidney Disease: Improving Global Outcomes (KDIGO) stage 3 AKI, kidney replacement therapy (KRT) use, and associated risk factors in pediatric trauma patients.

Methods

Pediatric patients (< 18 years) in the Trauma Quality Improvement Program (TQIP) database from 2017–2023 were analyzed for stage 3 AKI. Multivariable logistic regression (MVLR) identified associations between AKI and adverse outcomes, adjusting for confounders. Serious injury was defined as an abbreviated injury scale (AIS) ≥ 3 per body region.

Results

Among 867,467 pediatric trauma cases, 510 developed stage 3 AKI. Compared to children without stage 3 AKI, affected children had higher median composite injury severity scores (4 versus 26, p < 0.001) and lower survival (98% versus 69%, p < 0.001). In the MVLR model, older children, male sex (OR 1.20, 95% CI: 0.97–1.49), serious injury to the head/neck (3.48, 2.84–4.28), thorax (2.50, 2.00–3.11), abdomen (5.90, 4.79–7.28), extremities (2.26, 1.84–2.79), and skin (3.16, 2.14–4.68), in-hospital cardiac arrest (8.18, 6.24–10.72), pulmonary embolism (3.88, 1.97–7.66), sepsis (36.32, 23.83–55.37), ventilator-associated pneumonia (3.10, 1.96–4.91), acute respiratory distress syndrome (1.73, 1.03–2.89), and extracorporeal support (9.34, 5.51–15.85) were associated with stage 3 AKI. Patients with urologic injuries had higher rates of stage 3 AKI (0.6% vs. 0.046%, p = 0.0001). KRT was used in 20% of stage 3 AKI cases.

Conclusions

Stage 3 AKI was rare in pediatric trauma but strongly linked to abdominal, head/neck, and urologic injuries. Mortality was markedly increased when stage 3 AKI occurred.