Is Excretory-Phase Computerized Tomography Important for Evaluation of Pediatric High-Grade Renal Trauma?

There are no standardized guidelines for evaluation of pediatric renal trauma. We hypothesize that screening radiographic studies performed to rule out traumatic renal injuries in children can initially be evaluated by contrast-enhanced CT scans that lack an excretory phase.

We retrospectively collected data from 5 pediatric trauma centers between 2007 and 2020. Patients younger than 18 years with American Association for the Surgery of Trauma grade 3 or higher renal trauma were included. Outcomes data included rate for delayed surgical or radiologic interventions, complications, or readmissions related to the initial renal injuries.

Three hundred fifty-one children were included. Thirty-six percent (127/351) had excretory-phase CT (EPCT) at initial evaluation. The median age was 13.6 (IQR, 9.1-16.3) years. Grade IV/V injury was present in 56.7% (72/127) of EPCT patients vs 53.6% (120/224) of patients with nonexcretory-phase CT (NEPCT; P = .3). Ninety-six percent (338/351) were blunt injuries. NEPCT patients had higher median injury severity scores (21 vs 16, P < .01). EPCT children did not have more urinary drainage procedures (ureteral stent or percutaneous drain; 18% vs 12%, P = .11). Patients with initial NEPCT did not experience longer hospital stay (P = .46), increased complications (P = .52), or readmissions (P = .54). Importantly, gross hematuria (GH) significantly predicted need for renal procedures (odds ratio = 2.06, 95% CI, 1.28-5.2, P < .001).

Patients with initial NEPCT did not experience increased adverse outcomes or readmission. Those presenting with GH had increased risk of higher-grade renal injury and need for a renal procedure. This study suggests that high-grade pediatric renal trauma can be safely evaluated with NEPCT in initial trauma workup unless they present with GH.