Is Excretory Phase Computerized Tomography Important for Evaluation of Pediatric High-Grade Renal Trauma?

Abstract

Purpose: There are no standardized guidelines for evaluation of pediatric renal trauma. We hypothesize that screening radiographic studies performed to rule out traumatic renal injuries in children can initially be evaluated by contrast-enhanced CT scans that lack an excretory phase.

Materials and methods: We retrospectively collected data from five pediatric trauma centers between 2007-2020. Patients younger than 18 years old with renal trauma AAST grade 3 or higher were included. Outcomes data includes the rate for delayed surgical or radiologic interventions, complications, or readmissions related to the initial renal injuries.

Results: 351 children were included. 36% (127/351) had excretory-phase CT (EPCT) at initial evaluation. Median age was 13.6 (IQR 9.1-16.3) years. 56.7% (72/127) EPCT patients had grade IV/V injury vs. 53.6% (120/224) in NEPCT (p=0.3). 96% (338/351) were blunt injuries. NEPCT patients had higher median injury severity scores (21 vs. 16, p<0.01). EPCT children did not have more urinary drainage procedures (ureteral stent or percutaneous drain) (18% vs. 12%, p=0.11). Patients with initial NEPCT did not experience longer hospital stay (p=0.46), increased complications (p=0.52) or readmissions (p=0.54). Importantly, gross hematuria significantly predicted need for renal procedures (OR = 2.06, 95% CI 1.28-5.2, p < 0.001).

Conclusion: Patients with initial NEPCT did not experience increased adverse outcomes or readmission. Those presenting with gross hematuria had increased risk of higher-grade renal injury and need for renal procedure. This study suggests that high-grade pediatric renal trauma can be safely evaluated with NEPCT in initial trauma workup unless they present with gross hematuria.