Instituting a conservative management protocol for pediatric blunt renal trauma: evaluation of a prospectively maintained patient registry

Abstract

Purpose: Retrospective studies show that even high grade pediatric renal trauma can be safely managed conservatively. We evaluated a prospective patient registry at our level 1 pediatric trauma center, where patients with renal trauma were treated with an institutional review board approved conservative blunt renal trauma protocol. Standardized treatment included a trial of expectant management for all stable cases. Materials and Methods: We identified 39 children with blunt renal trauma treated between 2003 and 2008. A strict conservative approach was used, ie nonoperative management in cases that were hemodynamically stable or had a favorable response with up to 2 units of blood transfused and no operative renal lesion on imaging. Adult imaging protocols were followed and exploratory laparotomy for nonrenal causes did not alter course of expectant renal management. Outcomes evaluated were injury grade, hematuria, operative management, length of stay and associated injuries. Results: Based on the American Association for the Surgery of Trauma organ injury severity scale, 13 patients were considered to have grade I disease, 8 grade II, 11 grade III, 6 grade IV and 1 grade V. Conserva

Management of paediatric high‐grade blunt renal trauma: a 10‐year single‐centre UK experience

“…In all, 18 children (12 boys, six girls) with mean (range) age 11 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) years were included. According to the AAST grading criteria, 39% (seven of 18) of the patients had grade III, 50% (nine of 18) grade IV, and 11% (two of 18) grade V injuries; 44% (eight of 18) had concomitant injuries.…”

“…Examining the literature, there is a distinct lack of comprehensive paediatric-specific guidelines for management and aftercare of patients sustaining high-grade renal injury. Some centres have adopted the renal trauma guidelines for adults [4]. Systematic reviews have made an effort to offer recommendations with limited expert consensus agreement [5,6].…”