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Management of pediatric blunt renal trauma: A systematic review
Elyse LeeVan1, Osnat Zmora, Francesca Cazzulino
1From the Department of General Surgery (E.L.V.), Huntington Hospital, Pasadena; Division of Pediatric Surgery (F.C., R.V.B., J.Z., J.S.U.), Children's Hospital Los Angeles; and Keck School of Medicine (R.V.B., J.S.U.), University of Southern California, Los Angeles, California; and Tel Aviv Sourasky Medical Center (O.Z.), Tel Aviv, Israel.
Insights
Conservative management is effective for high-grade pediatric blunt renal trauma. This approach shows favorable outcomes, with emergent surgery reserved for hemodynamic instability. Further research is needed to refine protocols.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Nephrology
Background:
- Blunt trauma is a major cause of death and illness in children.
- Conservative management of blunt renal trauma is increasingly accepted in pediatric cases.
- Current practices, success rates, and outcomes of conservative pediatric blunt renal trauma management require review.
Purpose of the Study:
- To review current practices in managing pediatric blunt renal trauma.
- To highlight conservative management protocols and their success rates.
- To analyze short- and long-term outcomes of blunt renal trauma management in children.
Main Methods:
- Systematic review of PubMed, Ovid, and Cochrane Library databases.
- Search terms included "Renal/Kidney", "Pediatric/Children", "Trauma", and "Management" published after January 1, 2000.
- Included original research on high-grade (IV-V) pediatric blunt renal trauma with multiple patients; excluded reviews and meta-analyses.
Main Results:
- 308 titles/abstracts were screened, yielding 32 eligible articles.
- The literature supports conservative management for high-grade pediatric blunt renal trauma.
- Minimally invasive interventions like angioembolization are useful when indicated.
Conclusions:
- Conservative management protocols are supported for high-grade blunt pediatric renal trauma.
- Emergent operative intervention should be reserved for hemodynamic instability.
- Favorable short- and long-term outcomes are associated with conservative management of Grade IV and V renal injuries, though further prospective studies are needed.
Background:
Blunt trauma remains a significant cause of morbidity and mortality in the pediatric population. The use of conservative management for blunt renal trauma is widely accepted in adult trauma literature and is now increasingly accepted for use in the pediatric patient population. This study aimed to review current practices in pediatric blunt renal trauma management and to highlight current practices in conservative protocols, success rates of conservative management strategies, as well as short- and long-term outcomes of blunt renal trauma management.
Methods:
This is a systematic review of PubMed, Ovid, and the Cochrane Library. The following search was performed in each of the three databases: (Renal or Kidney) AND (Pediatric or Children) AND Trauma AND Management. Publications were limited to publish date after January 1, 2000. Inclusion criteria were (1) original research articles regarding management of pediatric blunt renal trauma, (2) involvement of cases of high-grade renal (Grades IV and V) trauma, and (3) more than one patient presented per study. Literature reviews and meta-analyses were excluded.
Results:
Titles and abstracts (n = 308) were screened to identify scientific articles reporting original research findings. A total of 32 articles met the selection criteria and were included in the review.
Conclusion:
The literature supports application of conservative management protocols to high-grade blunt pediatric renal trauma. Criteria for early operative intervention are not well understood. At this time, emergent operative intervention only for hemodynamic instability is recommended. Minimally invasive interventions including angioembolization, stenting, and percutaneous drainage should be used when indicated. Short- and long-term outcomes are favorable when using conservative management approaches to Grade IV and V renal injuries. Further studies including prospective studies and randomized control trials are necessary. Cost analyses of current treatment protocols are also necessary to guide efficient management strategies.
Level Of Evidence:
Systematic review, level III.
