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Efficacy of radiographic imaging in pediatric blunt renal trauma
A F Morey1, J E Bruce, J W McAninch
1Department of Urology, University of California School of Medicine, San Francisco, USA.
Insights
Radiographic imaging is not effective for detecting significant renal injuries in children with blunt trauma and minimal hematuria. Most cases involve minor contusions, with few severe injuries observed.
Area of Science:
- Pediatric Traumatology
- Diagnostic Imaging in Urology
- Emergency Medicine
Background:
- Blunt abdominal trauma in children can cause renal injuries.
- Hematuria is a common indicator of renal trauma.
- The role of imaging in children with minimal hematuria is unclear.
Purpose of the Study:
- To evaluate the effectiveness of radiographic imaging in detecting significant renal injuries in pediatric patients with blunt trauma and minimal hematuria.
- To determine if imaging is necessary for children with blunt trauma and less than 50 red blood cells per high power field in urinalysis.
Main Methods:
- Retrospective review of 180 pediatric patients with suspected renal trauma (1977-1995).
- Correlation of excretory urography or abdominal CT findings with urinalysis and clinical outcomes.
- Analysis of patients with microscopic and gross hematuria, and those who did not undergo imaging.
Main Results:
- In patients with microscopic hematuria, imaging revealed only 1 significant renal injury (grade ≥2) among 77 children.
- No significant injuries were found in children with microscopic hematuria and shock.
- Significant renal injuries were rare (2%) in children with minimal hematuria after blunt trauma, often associated with other injuries.
Conclusions:
- Significant renal injuries are uncommon in pediatric blunt trauma patients without gross or substantial microscopic hematuria.
- Radiographic imaging may not be necessary for children with minimal hematuria and blunt trauma.
- Shock is not a reliable indicator for significant renal injury in this population.
Purpose:
We sought to determine whether radiographic imaging can effectively detect significant renal injuries in children with blunt trauma who do not have significant hematuria.
Materials And Methods:
We reviewed the records of 180 children who presented to our hospital for suspected renal trauma between 1977 and 1995. Results of excretory urography or abdominal computerized tomography were correlated with urinalysis findings and clinical outcome.
Results:
Of 147 patients with microscopic hematuria after blunt trauma 77 underwent imaging. Only 1 patient had a significant renal injury (grade 2 or greater) and 76 had normal findings or renal contusions only, including 11 with microscopic hematuria and shock. Of the 74 patients who did not undergo imaging a clinical diagnosis of renal contusion was made and followup was available for 57 (77%). All patients healed without adverse sequelae. Of 33 patients with gross hematuria significant renal injuries were found in 9, including 3 who required immediate surgical repair of a major renal laceration or vascular injury. Combining our results with those of other reported series revealed significant renal injuries in only 11 of 548 children (2%) with less than 50 red blood cells per high power field on presenting urinalysis after blunt abdominal trauma. These patients were likely to have multiple associated injuries.
Conclusions:
Significant renal injuries are unlikely in pediatric patients with blunt renal trauma but no gross or substantial microscopic hematuria. Shock does not appear to be a clinically useful indicator.