Variation in management of pediatric post-traumatic urine leaks

Area of Science:

• Pediatric Traumatology
• Urology
• Nephrology

Background:

• High-grade pediatric renal trauma can lead to urine leaks.
• Current management strategies for traumatic pediatric renal urine leaks are not well-defined.

Purpose of the Study:

• To analyze the incidence, diagnosis, and management of urine leaks in pediatric patients with high-grade renal trauma.
• To evaluate outcomes and identify factors influencing management decisions.

Main Methods:

• Retrospective review of a pediatric level 1 trauma center's registry (15-year period).
• Analysis of demographics, diagnoses, imaging (including computerized tomography - CT), interventions, and follow-up for patients with urine leaks.
• Comparison of outcomes between patients who did and did not receive intervention for their urine leak.

Main Results:

• 187 renal injuries identified; 32 (17%) were high-grade, with 21 (11%) resulting in urine leaks.
• Urine leaks were diagnosed 0-10 days post-injury; 48% lacked initial excretory-phase CT imaging, necessitating repeat scans.
• 48% of patients required no intervention for their leak, while 52% underwent interventions, most commonly stent placement. No significant difference in Injury Severity Score (ISS) or Shock Index - Pediatric Adjusted (SIPA) between groups.

Conclusions:

• Traumatic urine leaks in children are infrequent, and approximately half do not necessitate intervention.
• Management approaches are variable, suggesting a need for standardized care guidelines to reduce variation.
• The rarity of these injuries underscores the necessity for multi-institutional studies to gather sufficient data for robust evidence-based guidelines.