NONOPERATIVE MANAGEMENT OF BLUNT PEDIATRIC MAJOR RENAL TRAUMA

Although algorithms exist for the management of renal trauma in adults , guidelines have not been established in children. Of 1,175 patients entered into our Trauma Registry between 1987 and 1991, 61 (5.2%) pres ented with gross or microscopic hematuria. Eight of the 58 patients (1 3.8%) who had blunt abdominal trauma had major renal injuries. Gross h ematuria (n = 10) was a significant predictor of major renal injury (n = 5) (p < 0.001). All 3 patients with microscopic hematuria and a maj or renal injury also had evidence of multisystem trauma. Admission blo od pressure, hemoglobin, and trauma score were not predictors of major renal trauma. All cases were managed nonoperatively except for 1 pati ent who required a partial nephrectomy for continued hemorrhage. These data suggest that hematuria of any degree should be evaluated in the pediatric population, since major injuries can occur with even microsc opic hematuria or in the absence of shock. Nonoperative management in this series resulted in no morbidity or delayed complications and sugg ests that surgical exploration be reserved for ongoing bleeding.