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Blunt traumatic hematuria in children. Is a simplified algorithm justified?
Marcos R Perez-Brayfield1, John M Gatti, Edwin A Smith
1Division of Pediatric Urology, Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.
The Journal of Urology
|May 7, 2002
Summary
Radiographic evaluation for pediatric traumatic hematuria is recommended only for children with 50+ red blood cells/high power field, hypotension, or severe injury mechanisms. This approach avoids unnecessary imaging in most cases, ensuring efficient diagnosis for traumatic renal injuries.
Area of Science:
- Pediatric Traumatology
- Emergency Medicine
- Radiology
Background:
- Traumatic hematuria in children often prompts radiographic evaluation.
- Current practice involves routine imaging for all pediatric patients with hematuria.
- The necessity of universal radiographic assessment requires further investigation.
Purpose of the Study:
- To determine the indications for radiographic evaluation in children with traumatic hematuria.
- To identify specific clinical factors that warrant imaging in this patient population.
Main Methods:
- Retrospective review of 110 children (ages 1-18) with blunt trauma and hematuria from 1992-1999.
- Analysis of injury mechanism, hematuria degree, hypotension, imaging studies, renal injury, and outcomes.
- Evaluation of routine radiographic practice in the emergency department.
Main Results:
- 22% of patients had significant renal injury; 0.9% had ureteropelvic junction avulsion.
- Renal anomalies were incidentally found in 8% of patients.
- Patients with significant injury or anomalies typically had >50 red blood cells/high power field or severe injury mechanisms.
Conclusions:
- Recommend selective radiographic evaluation based on urinalysis findings (≥50 RBCs/hpf), hypotension, or severe injury mechanisms.
- Consider imaging for high-risk mechanisms like high-speed motor vehicle accidents.
- Selective imaging can optimize resource utilization while ensuring diagnosis of significant injuries.