OBJECTIVE: To evaluate characteristics, hospital course, and outcomes of pediatric high-grade renal trauma (HGRT) using the Traumatic Renal Injury Collaborative in Kids consortium. METHODS: This was a retrospective cohort study of a large, multi-center registry of HGRT. 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: Out of the 315 patients included, most were male (69.5%) with blunt renal trauma (96.2%). 61% of patients were transferred to a level 1 trauma center. Those with higher injury grade had higher injury severity score (ISS) (ISS 14 vs 17 vs 25
P = .003), greater need for surgical procedures (0.7% vs 8.3% vs 21.2%
P =<
.001), and higher complication rates (14.6% vs 20.7% vs 33.3%
P = .043). Demographics and practice patterns differed between institutions, including ISS severity, use of delayed imaging, IR intervention, and urology consult, and repeat imaging. CONCLUSION: Pediatric HGRT has overall low morbidity and mortality. Most injuries occurred in males following blunt renal trauma secondary to motor vehicle collision. Hospital course and outcomes were dependent on renal grade, with practice patterns and follow-up differing between institutions. The current registry provides updated information on pediatric HGRT in the clinical setting for counseling and guide decision making. The differences noted in site specific management also allow for comparison across sites, identify areas of need, and to implement future improvements.