Related Experiment Videos
Management of kidney injuries in children with blunt abdominal trauma
L M Wessel1, S Scholz, I Jester
1Kinderchirurgische Klinik and Kinderklinik, Mannheim, Germany.
Insights
Pediatric blunt abdominal trauma requires prompt evaluation for renal injuries. Ultrasonography and urinalysis are key for initial screening, with CT scans essential for precise grading and guiding treatment decisions.
Area of Science:
- Pediatric surgery
- Trauma management
- Urology
Background:
- Blunt abdominal trauma is a significant concern in pediatric patients.
- Renal injuries are a common complication of such trauma.
- Effective initial management is crucial for patient outcomes.
Purpose of the Study:
- To analyze the incidence and course of renal injuries in pediatric blunt abdominal trauma.
- To evaluate the early diagnostic and therapeutic approaches.
- To provide recommendations for effective initial management.
Main Methods:
- Retrospective review of 308 pediatric patients with blunt abdominal trauma (1976-1996).
- Initial evaluation included urinalysis, ultrasonography, and abdominal paracentesis.
- Advanced imaging such as CT scans and angiography were used for specific cases.
- Renal trauma was classified using the Organ Injury Scaling (OIS) system.
Main Results:
- 36 patients had renal lesions grade 2 or higher; 20 were polytraumatized.
- Ultrasonography and urinalysis were optimal for screening and monitoring renal injuries.
- CT scans were most reliable for grading renal lesions (grade 2 and higher).
- Ten patients required operative therapy, with a trend towards minimally invasive approaches for severe injuries (grade 4 or 5).
Conclusions:
- Ultrasonography and urinalysis are optimal for initial screening and follow-up of renal injuries.
- CT scans provide accurate classification of renal trauma.
- A shift towards conservative management was observed over the study period.
- Surgical intervention, preferably minimally invasive, is indicated for severe renal injuries (grade 4-5).
Background/Purpose:
The authors analyzed the incidence and the course of renal injuries encountered in a cohort of pediatric patients with blunt abdominal trauma. This review focuses on the early diagnostic and therapeutic approach rather than the long-term outcome and draws conclusions for an effective initial management.
Methods:
From 1976 to 1996, the charts of 308 children with blunt abdominal trauma that were admitted to the authors' department were reviewed. The patients initially were evaluated using urinalysis, ultrasonography, and abdominal paracentesis (until 1984) and in specific cases iv-urography, computed tomography (CT), and angiography. The authors retrospectively classified the renal trauma after the widely used Organ Injury Scaling (OIS) into 5 grades and correlated the diagnostic value of various techniques as well as the diagnostic approach.
Results:
Sixty-nine serious abdominal traumas were encountered. Thirty-six patients suffered renal lesions grade 2 (G2) or higher; 20 children were polytraumatized. There were 67 renal lesions including 28 G1, 22 G2, 8 G3, 5 G4, 1 G5, and 3 lesions of the lower urinary tract. Ultrasonography and urinalysis were found to be the optimal diagnostic methods for screening and following the course of renal injury. CT scan proved to be most reliable for detecting and exactly classifying renal lesions grade 2 or higher and superseded consecutively iv-urography. In cases in which CT scan failed to show renal excretion of contrast agent, angiography was performed. Ten patients proceeded to operative therapy.
Conclusions:
Ultrasonography and urinalysis proved to be the optimal initial evaluation tool for excluding renal injury both as a screening method and for further controls. Exact classification was possible by CT scan. During the reviewed time period a shift from surgical to conservative management was notable. If lesions were G4 or G5, surgical treatment with tendency toward minimally invasive therapy always was indicated.