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, K. D., Juang, D., Notrica, D., Grandsoult, V. L., Acosta, J., Sharp, S. W., Murphy, J. P., St Peter, S. D. Prospective observational study with an abbreviated protocol in the management of blunt renal injury in children. Journal of pediatric surgery 49, 198-200 (2014).