Management of Paediatric High Grade Blunt Renal Trauma: A 10 Year Single Centre UK Experience

Wong, KY, JEENEEA, R, HEALEY, A, Abernethy, L, CORBETT, H, McANDREW, HF and Losty, PD ORCID: 0000-0003-0841-5879 (2018) Management of Paediatric High Grade Blunt Renal Trauma: A 10 Year Single Centre UK Experience. British Journal of Urology (BJU) International, 121 (6). pp. 923-927.

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Abstract

OBJECTIVE:To report the management and outcome of paediatric patients sustaining high-grade blunt renal trauma. PATIENTS AND METHODS:Medical records were examined for all American Association for the Surgery of Trauma (AAST) grade III-V blunt renal trauma cases admitted to a paediatric trauma centre from 2005 to 2015. Data collected and analysed included: demographics, imaging modalities, management, length of hospital stay (LOS), complications, and follow-up outcomes. RESULTS:In all, 18 children (12 boys, six girls) with mean (range) age 11 (4-15) 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. Most of the patients were managed conservatively (89%, 16 of 18), although two of the 16 subsequently needed JJ-stent insertion during inpatient stay for symptomatic urinoma(s). In all, 11% (two of 18) of the patients required interventional radiology service(s), involving selective embolisation for life-threatening renal tract haemorrhage. Blood transfusion for renal injury exclusively was required in 11% (two of 18) of the patients. In all, 89% (16 of 18) of the patients had at least one follow-up imaging study before hospital discharge; most (13 of 16) had ultrasonography and three required computed tomography. The median (range) LOS was 11 (4-31) days. In all, 17% (three of 18) of the patients required hospital re-admission within 30 days for complications and all required interventional procedures: JJ stent for urinoma (one), embolisation of renal arterio-venous fistula (one), and embolisation for a post-traumatic pseudoaneurysm (one). Overall, the median (range) follow-up was 6 (2-60) months. In all, 78% (14 of 18) of the patients had dimercaptosuccinic acid studies, with 11 showing reductions in renal function (range 3-44%). CONCLUSIONS:This study supports a care pathway strategy advocating conservative management of high-grade renal injuries in children. However, patients may experience a relative decline in renal function with higher grade injuries indicating the need for monitoring and follow-up.

Item Type:	Article
Uncontrolled Keywords:	paediatric, blunt, renal trauma, conservative management
Depositing User:	Symplectic Admin
Date Deposited:	13 Feb 2018 15:05
Last Modified:	19 Jan 2023 06:39
DOI:	10.1111/bju.14142
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3018093