Does race and insurance status play a role in high-grade renal trauma in the pediatric population? - An analysis from the traumatic renal injury collaborative in kids (TRICK) consortium

Background: We sought to examine the potential role of race and insurance status on the presentation, management, and outcomes of high-grade renal trauma (HGRT) in a large trauma registry. Methods: A retrospective cohort study of a large, multi-center registry of high-grade pediatric renal trauma was performed. Patients < 18 years of age with HGRT (grades III, IV, and V) from 2007 to 2020 were included. Patient demographics, presenting characteristics, hospital courses, outcomes, and follow-ups were extracted and compared. Results: A total of 341 patients were initially identified, 32 were excluded. 66.3% were Caucasian(C), 27.5% were African American(AA), and 6.2% were Other races(O). 43.7% had public insurance,49.8% had private insurance and 6.5% were self-pay. Association of Race: AA patients had a higher rate of penetrating trauma (9% AA vs. 4% C, 0% Others, p = 0.002). Those with O and AA races presented at a younger age (9.5 yo O vs. 12.5 yo AA vs. 14 yo C, p = 0.001). However, no differences were found between race groups in the hospital course or outcome. Association of Insurance status: Those with public insurance presented with higher rates of bowel injury and blood transfusion, no differences were found in hospital course or outcome. Private insurance had higher Urology follow up rates (49% Private vs. 34.6% Public vs. 35% Self pay, p = 0.041). Conclusions: Race and insurance status was associated with differences found on the mechanism of injury, transfusion rate and urology follow-up rate; however, they do not influence rates of surgical intervention, post-injury complications or mortality.