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Traumatic hematuria in children can be evaluated as in adults
Richard A Santucci1, Scott E Langenburg, Michael J Zachareas
1Department of Urology, Wayne State University School of Medicine, Detroit, Michigan 48201, USA. rsantucc@med.wayne.edu
Insights
Pediatric blunt abdominal trauma patients with microhematuria do not routinely require renal imaging. Applying adult criteria of gross hematuria, shock, or significant deceleration injury appropriately identifies all significant renal injuries in children.
Area of Science:
- Pediatric Urology
- Trauma Surgery
- Diagnostic Imaging
Background:
- Microhematuria in pediatric blunt abdominal trauma raises questions about the necessity of renal imaging.
- Established adult trauma imaging criteria may not directly translate to pediatric populations.
Purpose of the Study:
- To evaluate the applicability of adult renal imaging criteria to pediatric blunt abdominal trauma patients.
- To determine if adult criteria can accurately identify significant renal injuries in children.
Main Methods:
- Retrospective review of 720 pediatric patients with suspected renal trauma.
- Analysis of injury mechanisms, imaging evaluations, and treatment outcomes.
Main Results:
- 59 renal injuries identified among 720 patients; 334 underwent imaging.
- Significant injuries (grades IV-V) were associated with gross hematuria, shock, or deceleration.
- Only 3 nephrectomies were performed, with conservative management for most injuries.
Conclusions:
- Adult criteria (gross hematuria, shock, significant deceleration) are appropriate for imaging pediatric trauma patients.
- These criteria effectively identify all significant renal injuries in the pediatric population, avoiding unnecessary imaging.
Purpose:
Controversy exists regarding whether children who present with blunt abdominal trauma and microhematuria should undergo renal imaging. Adult blunt trauma victims who present without gross hematuria, shock, or significant deceleration or other major associated injuries do not require renal imaging. This study was designed to evaluate whether the criteria for imaging the renal parenchyma in adult blunt trauma victims apply to the pediatric population.
Materials And Methods:
We retrospectively reviewed 720 consecutive pediatric patients with suspected renal trauma to determine mechanism of injury, evaluation and treatment of subsequent injuries.
Results:
Of the 720 trauma patients with hematuria (mean age 8 years) 334 underwent imaging, and 59 renal injuries were identified (grade I 32, grade II 6, grade III 8, grade IV 12, grade V 1). A total of 11 patients underwent exploration, resulting in 3 nephrectomies (grade IV 2, grade V 1). Renorrhaphy was not necessary and all other cases were managed conservatively. All patients with significant renal injuries experienced either gross hematuria, shock (systolic blood pressure less than 90 mm Hg) or a significant deceleration injury.
Conclusions:
The decision to image pediatric trauma cases based on the adult criteria of gross hematuria, shock and significant deceleration injury is appropriate. Among 720 pediatric cases of potential renal injury all would have been identified.
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