Prospective observational study with an abbreviated protocol in the management of blunt renal injury in children.
BACKGROUND: There are no published management schemes for blunt renal injuries. We are conducting a 2-center prospective observational study with a fixed management scheme.
METHODS: Children with CT proven renal injuries were enrolled with permission. Ambulation is allowed when able regardless of grade. Discharge occurs when tolerating a diet and pain is controlled regardless of hematuria. Urinalysis occurs at follow up in 2-4weeks and repeated as indicated.
RESULTS: Between 9/2008 and 9/2012, 70 patients were enrolled. Mean age was 11.8years (3-17), and 70% were male. The mean grade of injury was 2.8±1.1 [1-5]. One nephrectomy (1.4%) was performed for a grade 5 injury. Other renal interventions included an embolization for the hilar bleed and one cystotomy for a clot. Mean LOS was 2.9days±2.4days. In patients without other major injury, LOS was 1.9±1.7days (0.4-8days). There were 5 (7%) readmissions: 3 for pain, 1 for hematuria, and 1 for a bladder clot. 58 patients (83%) gave urinalysis samples at initial follow up (med 18days), where 31 (53%) were positive for blood.
CONCLUSIONS: Children with blunt renal injury may benefit from management without strict bedrest guidelines. Hematuria appears to have little influence on recovery.
Journal of pediatric surgery
Adolescent; Bed Rest; Child; Child, Preschool; Clinical Protocols; Diet; Disease Management; Embolization, Therapeutic; Female; Hematuria; Humans; Infant; Kidney; Male; Multiple Trauma; Nephrectomy; Pain Management; Practice Guidelines as Topic; Prospective Studies; Tomography, X-Ray Computed; Trauma Severity Indices; Urinalysis; Walking; Wounds, Nonpenetrating
Children; Management; Renal trauma
Graziano, Kathleen D.; Juang, David; Notrica, David; Grandsoult, Victoria L.; Acosta, Juan; Sharp, Susan W.; Murphy, J Patrick; and St Peter, Shawn D., "Prospective observational study with an abbreviated protocol in the management of blunt renal injury in children." (2014). Manuscripts, Articles, Book Chapters and Other Papers. 790.