PURPOSE: We sought to determine which pediatric patients sustaining blunt grade IV renal trauma are at highest risk for failing non-operative management and in what time frame those patients will likely present.
MATERIALS AND METHODS: We retrospectively reviewed children with non-vascular grade IV blunt renal trauma between 2003-2012. We compared characteristics on computerized tomography, reasons for intervention, type of and timing of surgery, length of stay (LOS) and need for readmission between patients undergoing early intervention (< 72 hours after admission) versus patients in whom conservative management was attempted, with any interventions occurring >72 hours after admission.
RESULTS: Twenty-six children were identified with non-vascular grade 4 blunt renal trauma. Conservative management was attempted on 16 (62%) patients. Seven (44%) of these patients required intervention (ureteral stent and/or percutaneous drain placement) with a mean time to intervention of 11 days. Collecting system clot and larger urinoma (1.45cm vs 4.29cm) significantly predicted failure of conservative management (P< 0.05). Presence of dissociated renal fragments (57% vs 11%) and interpolar contrast extravasation (57% vs 0%) were more common in the intervention group (P>0.05), as were readmissions (43% vs 0%), mean LOS (7.9 vs 5.4 days) and transfusions (14% vs 0%) (P>0.05).
CONCLUSIONS: Collecting system hematoma and urinoma size significantly predicted failure of conservative management with a mean time to intervention of 11 days. Patients who failed conservative management had a greater incidence of dissociated renal fragments and interpolar extravasation. Early identification of these children may reduce hospital readmissions, LOS and prolonged morbidity.
Written by:
Reese JN, Fox JA, Cannon GM Jr, Ost MC. Are you the author?
Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA; Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA; Lieutenant Commander, United States Navy, Naval Medical Center Portsmouth, Portsmouth, VA.
Reference: J Urol. 2014 Feb 21. pii: S0022-5347(14)00294-8.
doi: 10.1016/j.juro.2014.02.039
PubMed Abstract
PMID: 24565528
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