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Blunt renal trauma in children: experience with conservative management at a pediatric trauma center
Julie A Margenthaler1, Thomas R Weber, Martin S Keller
1Department of Pediatric Surgery, Cardinal Glennon Children's Hospital, St. Louis, Missouri 63104, USA.
Insights
Conservative management is effective for children with blunt renal injuries, with 87% successfully treated nonoperatively. This approach demonstrates favorable outcomes and low complication rates across various injury grades.
Area of Science:
- Pediatric Trauma Surgery
- Renal Injury Management
- Nonoperative Treatment Protocols
Background:
- Pediatric blunt renal injuries are common in trauma settings.
- Nonoperative management is increasingly explored for solid organ injuries.
- Evaluating outcomes of nonoperative protocols for pediatric blunt renal trauma is crucial.
Purpose of the Study:
- To review the outcomes of children with blunt renal injury treated nonoperatively.
- To assess the safety and efficacy of conservative management for all injury grades.
- To compare outcomes with established surgical intervention benchmarks.
Main Methods:
- Retrospective review of 55 children (0.5-17 years) with blunt renal injury over 14 years.
- All patients underwent computed tomographic (CT) scanning for injury evaluation.
- Injuries were graded using the American Association for the Surgery of Trauma Organ Injury Scale.
Main Results:
- 87% (48/55) of children achieved successful nonoperative management.
- High-grade injuries (IV and V) had higher surgical intervention rates (29% and 60% respectively).
- Most patients (93%) had normal blood pressure and renal function at follow-up.
Conclusions:
- Conservative management is supported for stable pediatric blunt renal injuries across all grades.
- Nonoperative treatment shows comparable transfusion and operative rates to other pediatric solid organ injuries.
- This approach offers a safe and effective alternative to surgery in select pediatric trauma patients.
Background:
The authors reviewed the outcome for children with blunt renal injury managed with a nonoperative protocol at their pediatric trauma center.
Methods:
Fifty-five consecutive children aged 0.5 to 17 years with blunt renal injury managed over a 14-year period were reviewed. All patients were evaluated with computed tomographic scanning. Injuries were graded according to the American Association for the Surgery of Trauma Organ Injury Scale.
Results:
Forty-eight of 55 children (87%) were successfully managed nonoperatively. Overall, there were 5 grade I, 13 grade II, 18 grade III, 14 grade IV, and 5 grade V injuries. All children with grades I and III injuries were successfully managed nonoperatively. Two (6%) of these children required transfusion. Only four (29%) children with grade IV and three (60%) with grade V injuries required surgical interventions (one nephrostomy, six nephrectomies). Excluding patients with continuing hemorrhage, only 2 (14%) of 14 with high-grade injuries required surgical intervention (1 nephrostomy, 1 nephrectomy). Clearance of gross hematuria correlated with severity of injury and was prolonged in grade IV and V compared with grade I to III injuries (6.8 +/- 2.7 vs. 3.2 +/- 2.1 days, respectively; p < 0.05). Fifty-one children (93%) available for follow-up were normotensive with normal renal function.
Conclusion:
These data support the use of conservative management for all grades in stable children with blunt renal injury. Transfusion requirements, operative rates, and outcome are consistent with other pediatric solid organ injuries.
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