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MODIYFING CURRENT INDICATIONS FOR IMAGING IN PEDIATRIC BLUNT RENAL
TRAUMA
Jason K AU
1
, Thomas STOUT
1
, Xishi TAN
1
, Irina STANASEL
1
, David R ROTH
1
, Edmond T GONZALES, JR.
1
, Duong TU
1
,
Abhishek SETH
1
, Chester J KOH
1
, Patricio C GARGOLLO
1
, Bindi NAIK-MATHURIA
2
and Nicolette JANZEN
1
1) Texas Children's Hospital / Baylor College of Medicine, Urology, Houston, USA - 2) Texas Children's Hospital / Baylor
College of Medicine, Surgery, Houston, USA
PURPOSE
Gross hematuria is seen in 1/3 of significant renal injuries in pediatric blunt renal trauma (PBRT). We analyze whether
eliminating gross hematuria and mechanism as imaging criteria in PBRT will affect rates of detection of high (AAST IV-V)
and low (AAST I-III) grade renal injury.
MATERIAL AND METHODS
We performed a retrospective review of our PBRT database 1995-2015, stratifying patients into two cohorts: high grade
and low grade injury, and analyzed PE findings (abdominal/flank tenderness or bruising), N/V, and gross
hematuria. Patients with incomplete data were excluded. Statistics were performed by Fisher’s exact test (SPSS v. 21).
RESULTS
Of 74 renal injuries, 23 were high grade (all AAST IV) and 51 were low grade (19 grade III, 13 grade II, 19 grade I).
Median age was 12.4 years (0.1-19.6). Comparing high v. low grade cohorts: 100% v. 78% patients manifested
abdominal/flank pain on PE (p= 0.0135), 56.5% v. 24% had N/V (p=0.0088), and 90% v. 78% had gross hematuria
(p=0.5250). Using the criteria 1) abdominal/flank pain or 2) N/V for scanning, one CT in the high grade cohort v. seven
in the low grade cohort would NOT have been performed (p=0.4218), however all these patients were managed non-
operatively and did not require blood transfusions. In the high grade cohort, 4 patients required double J stenting and
one patient had angioembolization, all of which would have been scanned based on the criteria above. No trauma or
delayed nephrectomies were performed in any patients.
CONCLUSIONS
Our data suggests that indications for CT imaging in PBRT should include abdominal/flank PE findings and N/V, and
exclude mechanism and gross hematuria. A larger prospective multi-center trial is warranted to verify these findings.