BLUNT RENAL TRAUMA IN THE PEDIATRIC POPULATION - INDICATIONS FOR RADIOGRAPHIC EVALUATION

Objectives. The purpose of this study was to define more clearly the c linical indications for radiographic evaluation of blunt renal injury in the pediatric population. Methods. Children evaluated for blunt abd ominal trauma at the Children's Hospital of Los Angeles and Los Angele s County/University of Southern California Medical Center undergo rout ine physical examination, laboratory analysis, and computed tomography (CT) scan of the abdomen and pelvis regardless of urinalysis results. We retrospectively evaluated the abdominal and pelvic CT scans of 412 children sustaining blunt abdominal trauma between June 1985 and June 1990. A total of 48 children, ages 6 months to 14 years (mean 5.6 yea rs), with CT-documented renal injuries secondary to blunt trauma were identified. The radiographic findings were correlated with clinical pr esentation in this group of patients. Results. Of the 48 children sust aining renal injuries (12% of the group), 23 (48%) had renal contusion s and 25 children (52%) sustained more serious (significant) renal inj uries. Of the children with significant renal injuries, 17 (68%) had m inor renal lacerations and 8 (32%) had major renal lacerations. No chi ld sustained a renal pedicle injury. All 25 children sustaining signif icant renal injuries presented with hematuria: 17 (68%) had microscopi c (more than 3 red blood cells per high-power field) and 8 (32%) had g ross hematuria. In the 23 children with renal contusions, 4 (17%) had no hematuria, 13 (57%) had microscopic hematuria, and 6 (26%) presente d with gross hematuria. Hypotension occurred in 2 of the 25 children w ith significant renal injuries and in 2 of 23 children with renal cont usions. Fifteen of the 25 patients (60%) with significant renal injuri es had associated organ injuries, and 17 of the 23 children (74%) with renal contusions had associated organ injuries. Conclusions. In adult s, gross hematuria and microscopic hematuria with hypotension followin g blunt trauma have been correlated with significant renal injuries re quiring radiographic investigation. We conclude that these clinical cr iteria proposed to guide the radiographic evaluation of the adult popu lation with blunt trauma do not apply to children. In our study, the d egree of hematuria did not correlate with the degree of renal injury, and significant renal injury did occur with microhematuria in the abse nce of hypotension. We suggest that any child with a history of blunt abdominal trauma and any evidence of hematuria should undergo abdomina l and pelvic CT scanning for