Pediatric urologyPediatric renal trauma
Section snippets
Material and methods
A medical record search of patients discharged from January 1989 to July 1999 identified patients aged up to 18 years who were diagnosed with renal injury. Ninety-one patients with adequate documentation were initially identified. Only patients with objective data of renal trauma grade by either CT or operative exploration were included to ensure a more accurate diagnosis. Thirty patients whose clinical diagnoses of renal contusion were made solely on the basis of hematuria or for whom the
Results
In all, 46 patients sustained blunt injuries (75%) and 15 patients sustained penetrating injuries (25%). Complying with earlier reports, we categorized grade 1 as “minor” and grade 2-5 as “significant” injuries. Grade 1 injuries accounted for 14 (23%) and grade 2-5 injuries made up 47 (77%) of the 61 patients. Thirty-two (70%) of the 46 patients with blunt trauma and all 15 patients (100%) with penetrating injuries sustained significant grade 2-5 injuries. Five (11%) of 46 patients with blunt
Comment
To ascertain the most accurate grade of injury, we excluded patients diagnosed clinically by virtue of hematuria alone without imaging or operative evaluation. Because of this decision, there was a selection bias for higher grade injuries in our study. This resulted from the exclusion of low-grade injuries that were not evaluated with abdominal CT by the treating physician.
Conventionally, significant renal trauma refers to grade 2-5 injuries, and grade 1 renal contusion injuries are considered
Conclusions
Renal imaging is indicated in pediatric blunt abdominal trauma with any degree of hematuria because renal injuries have been associated with various degrees of hematuria. In patients with associated abdominal injuries, the assessment for renal injury should be done with imaging or exploration, regardless of the urinalysis result because of the possibility of significant injury requiring renal operative intervention even with normal urinalysis. We should also consider imaging patients with
References (27)
- et al.
Are pediatric patients more susceptible to major renal injury from blunt trauma? A comparative study
J Urol
(1998) - et al.
Radiographic assessment of renal traumaa 10-year prospective study of patient selection
J Urol
(1989) - et al.
Efficacy of radiographic imaging in pediatric blunt renal trauma
J Urol
(1996) - et al.
Preliminary experience with focused abdominal sonography for trauma (FAST) in childrenis it useful?
J Pediatr Surg
(1999) - et al.
Nonoperative management of blunt pediatric major renal trauma
Urology
(1993) - et al.
Management of kidney injuries in children with blunt abdominal trauma
J Pediatr Surg
(2000) - et al.
Correlation between urinalysis and intravenous pyelography in pediatric abdominal trauma
J Emerg Med
(1995) - et al.
The impact of computed tomography scanning on the child with renal trauma
J Pediatr Surg
(1986) - et al.
Genitourinary trauma in the pediatric patient
Pediatr Urol
(1993) - et al.
Investigation and management of blunt renal injuries in childrena review of 11 year’s experience
J Pediatr Surg
(1991)
Editorialimaging in pediatric blunt renal trauma
J Urol
Patterns of injury in children
J Pediatric Surg
The incidental discovery of occult abdominal tumors in children following blunt abdominal trauma
J Trauma
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Trauma in pediatric urology
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2019, European Urology FocusACR Appropriateness Criteria <sup>®</sup> Hematuria-Child
2018, Journal of the American College of RadiologyCitation Excerpt :Different threshold values have been used for evaluating post-traumatic microhematuria, but in general >50 red blood cells per high-power field has been used as a threshold for imaging [75,93]. Recent studies note, at best, a fair correlation between degree of microhematuria and risk or severity of renal injury [67,70-72]. A study on patients ≥16 years old by Olthof et al [94] showed that although the presence of macroscopic hematuria (n = 16) led to clinical consequences in 73% of the patients, microscopic hematuria on urinalysis in combination with no findings on imaging led to clinical consequences in only 8 of 212 patients (4%) and that microscopic hematuria on urinalysis in patients who did not undergo imaging for urogenital injury did not lead to clinical consequences (0 of 54 patients; 0%).