Missed Opportunities to Decrease Radiation Exposure in Children with Renal Trauma

Area of Science:

• Pediatric Urology
• Trauma Surgery
• Diagnostic Imaging

Background:

• Computerized tomography (CT) overuse is a concern in pediatric blunt abdominal trauma.
• Pediatric renal trauma management often involves imaging to assess injury severity and guide treatment.

Purpose of the Study:

• To evaluate the frequency and predictors of repeat computerized tomography (CT) in pediatric patients with blunt renal trauma.
• To determine if initial imaging timing influences the need for subsequent CT scans.
• To assess the utility of renal ultrasound in monitoring pediatric renal trauma.

Main Methods:

• Retrospective chart review of 145 pediatric patients (<18 years) with blunt renal trauma treated at two urban trauma centers (2002-2016).
• Data collected included demographics, injury grade, urological interventions, and timing/use of CT and renal ultrasound.
• Statistical analysis controlled for relevant clinical factors to identify predictors of repeat CT scans.

Main Results:

• 32% of patients underwent repeat CT scans during hospitalization, with 20% performed less than 48 hours after the initial scan.
• Delayed initial imaging was associated with decreased odds of repeat CT (adjusted OR 0.2).
• The number needed to treat to prevent one repeat scan in high-grade renal trauma was 3. Renal ultrasound showed 50% sensitivity and 94% specificity for detecting abnormalities requiring intervention.

Conclusions:

• Repeat CT scans are frequently performed in pediatric renal trauma.
• Optimizing initial imaging timing, particularly with delayed scans for high-grade injuries, may reduce the need for repeat CT.
• Renal ultrasound is a valuable tool for monitoring pediatric renal trauma and should be considered prior to repeat CT.