Pediatrik Ürogenital Travmada Beslenme Durumunun Klinik Sonuçlara Etkisi: Retrospektif Bir Analiz

Yıl 2025, Cilt: 47 Sayı: 6, 1057 - 1063, 26.09.2025

Çiğdem Arslan Alıcı , Gürkan Bozan , Baran Tokar , Muzaffer Bilgin

https://doi.org/10.20515/otd.1746688

Öz

Bu çalışmanın amacı, beslenme durumu, yaralanma şiddeti, morbidite ve mortalite arasındaki ilişkiler üzerinde odaklanarak, ürogenital travma geçiren pediatrik hastaların klinik sonuçlarını değerlendirmektir. 2016-2022 yılları arasında ürogenital travma nedeniyle hastaneye yatırılan 18 yaşın altındaki 53 hasta üzerinde retrospektif bir inceleme yapılmıştır. Demografik bilgiler, travma mekanizmaları, yaralanan organlar, sonuçlar ve vücut kitle indeksine (VKİ) dayalı beslenme durumu ile ilgili veriler toplanmıştır. Renal travma (RT), Amerikan Travma Cerrahisi Derneği'ne göre şiddetli (4-5. derece) veya şiddetli olmayan (1-3. derece) olarak sınıflandırılmıştır. İstatistiksel analizlerde, morbidite ve mortalite açısından VKİ grupları ve travma şiddeti karşılaştırılmıştır. BT, hastaların %39,6'sında saptanmış ve bu grupta makroskopik hematüri daha sık görülmüştür (p=0,021). Ekstra-genital organ travması (EGOT) hastaları daha fazla cerrahi müdahaleye ihtiyaç duyarken (p = 0,004), Renal travma(RT) hastalarında transfüzyon ihtiyacı daha yüksekti (p = 0,001). Morbidite, şiddetli RT vakalarında (%100) şiddetli olmayan vakalara (%5,88) göre anlamlı olarak daha yüksekti (p = 0,0008). Mortalite sadece RT grubunda (p = 0,020) görüldü ve çoğunlukla şiddetli kafa travması olan hastalarda meydana geldi. Mortalite, özellikle 50-59 kg ve 70-79 kg ağırlığındaki hastalarda (p = 0,0337) kilo ile önemli farklılıklar gösterse de, VKİ'nin kendisi sonuçlarla anlamlı bir ilişki göstermedi. Yaralanma şiddeti morbiditeyi etkileyen birincil faktör iken, mortalite ürogenital yaralanma şiddeti veya beslenme durumundan çok multisistemik travma ile ilişkiliydi. Bu bulguları doğrulamak için daha geniş prospektif çalışmalar gereklidir.

Anahtar Kelimeler

Pediatrik ürogenital travma , Beslenme durumu , Morbidite , Mortalite , Vücut kitle indeksi

Impact of Nutritional Status on Clinical Outcomes in Pediatric Urogenital Trauma: A Retrospective Analysis

Öz

This study aimed to evaluate clinical outcomes in pediatric patients with urogenital trauma, focusing on the associations among nutritional status, injury severity, morbidity, and mortality. A retrospective review was performed on 53 patients under 18 years admitted between 2016 and 2022 with urogenital trauma. Data on demographics, trauma mechanisms, injured organs, outcomes, and body mass index(BMI) -based nutritional status were collected. Renal trauma (RT) was classified as severe (Grade 4–5) or non-severe (Grade 1–3) according to the American Association for the Surgery of Trauma. Statistical analyses compared BMI groups and trauma severity with respect to morbidity and mortality. RT was found in 39.6% of patients, with gross hematuria more frequent in this group (p=0.021). Extrarenal genitourinary organ trauma(EGOT) patients required more surgical interventions (p = 0.004), while transfusion needs were higher in renal trauma(RT) patients (p = 0.001). Morbidity was significantly higher in severe RT cases (100%) than non-severe ones (5.88%) (p = 0.0008). Mortality occurred only in the RT group (p = 0.020), primarily in patients with severe head trauma. Although mortality showed significant variation by weight, especially among patients weighing 50–59 kg and 70–79 kg (p = 0.0337), BMI itself was not significantly associated with outcomes. Injury severity was the primary factor influencing morbidity, while mortality was more related to multisystem trauma rather than urogenital injury severity or nutritional status. Larger prospective studies are needed to validate these findings.

Anahtar Kelimeler

Pediatric urogenital trauma , Nutritional status , Morbidity , Mortality , Body mass index

Etik Beyan

This research is a noninvasive, clinical retrospective study that was approved by Eskisehir Osmangazi University, Ethics Committee of the Faculty of Medicine (Number 2022-09) and was conducted in accordance with the Declaration of Helsinki. All data are in the repository of Eskisehir Osmangazi University. The authors have no ethical conflicts to disclose.

Teşekkür

We thank Biostatistics Spc. Muzaffer Bilgin for his expertise and assistance in statistical analysis.

Kaynakça

• 1. Karabulut B, Özcan F, Azılı MN, Şenaylı A, Akbıyık F, Mambet E, Şenel E, Livanelioğlu YZ, Tiryaki T. Genitourinary System Trauma in Children. Turkish J Pediatr Dis. April 2014;8(4):186-191. 2. Grimsby GM, Voelzke B, Hotaling J, Sorensen MD, Koyle M, Jacobs MA. Demographics of pediatric renal trauma. J Urol. 2014 Nov;192(5):1498-502.
• 3. Gaillard F, Knipe H, Khalighinejad P, et al. AAST kidney injury scale. Reference article, Radiopaedia.org (Accessed on 29 Apr 2025)
• 4. Mahran A, Fernstrum A, Swindle M, Mishra K, Bukavina L, Raina R, Narayanamurthy V, Ross J, Woo L. Impact of trauma center designation in pediatric renal trauma: National Trauma Data Bank analysis. J Pediatr Urol. 2020 Oct;16(5):658.e1-658.e9.
• 5. Derinöz Güleryüz O. Çocuklarda genitoüriner sistem travmaları. Anıl M, editör. Pediatrik Travma. 1. Baskı. Ankara: Türkiye Klinikleri; 2020. p.60-9.
• 6. Tartar, T, Kazez A. Çocuklarda Üriner Sistem Travmaları.Turkiye Klinikleri Pediatric Surgery-Special Topics; 2018, 8(1), 36-44.
• 7. Ishida Y, Tyroch AH, Emami N, McLean SF. Characteristics and Management of Blunt Renal Injury in Children. J Emerg Trauma Shock. 2017;10(3):140-145.
• 8. Singer G, Arneitz C, Tschauner S, Castellani C, Till H. Trauma in pediatric urology. Semin Pediatr Surg. 2021 Aug;30(4):151085.
• 9. Wong KY, Jeeneea R, Healey A, Abernethy L, Corbett HJ, McAndrew HF, Losty PD. Management of paediatric high-grade blunt renal trauma: a 10-year single-centre UK experience. BJU Int. 2018 Jun;121(6):923-927.
• 10. Ceylan H, Gunsar C, Etensel B, Sencan A, Karaca I, Mir E. Blunt renal injuries in Turkish children: a review of 205 cases. Pediatr Surg Int. 2003 Dec;19(11):710-4.
• 11. McAleer IM, Kaplan GW, Scherz HC, Packer MG, Lynch FP. Genitourinary trauma in the pediatric patient. Urology. 1993 Nov;42(5):563-7; discussion 567-8.
• 12. Ringen AH, Fatland A, Skaga NO, Gaarder C, Naess PA. Pediatric renal trauma: 17 years of experience at a major Scandinavian trauma center. Trauma Surg Acute Care Open. 2023 Nov 14;8(1):e001207.
• 13. Durgun HM, Dursun R, Zengin Y, Özhasenekler A, Orak M, Üstündağ M, Güloğlu C. The effect of body mass index on trauma severity and prognosis in trauma patients. Ulus Travma Acil Cerrahi Derg. 2016 Sep;22(5):457-465.
• 14. Brown CV, Neville AL, Rhee P, Salim A, Velmahos GC, Demetriades D. The impact of obesity on the outcomes of 1,153 critically injured blunt trauma patients. J Trauma. 2005 Nov;59(5):1048-51; discussion 1051.
• 15. Carlson JP, Peña K, Burjonrappa S. The Obesity Paradox in the Pediatric Trauma Patient. J Pediatr Surg. 2024 Feb;59(2):275-280.
• 16. Lindberg L, Danielsson P, Persson M, Marcus C, Hagman E (2020) Association of childhood obesity with risk of early all-cause and cause-specific mortality: A Swedish prospective cohort study. PLoS Med 17(3): e1003078.