Computed tomography findings in patients with pediatric blunt renal trauma in whom expectant (nonoperative) management failed.

OBJECTIVE: To determine whether the features on a computed tomography (CT) scan can predict the need for urologic intervention in a pediatric blunt renal trauma population initially treated with expectant management.

MATERIALS AND METHODS: A review of a prospective database of pediatric patients sustaining renal trauma from 1991 to 2003 was performed. The data reviewed included the mechanism of injury, injury grade, CT findings, operative intervention, and complications. Parametric statistical analysis was used to compare the CT findings and outcomes.

RESULTS: A total of 72 children presented with blunt renal injury, of whom 61 met the study criteria. Of the 61 patients, 50 had grade I-III, 10 had grade IV, and 1 had grade V injuries. No children with grade I-III injuries required operative intervention. Of the 10 patients with grade IV injuries, 4 had medial contrast extravasation from the collecting system on their original CT scan, 3 of whom required intervention. Intervention initially consisted of delayed endoscopic procedures at 3, 9, and 33 days after injury. All 3 patients (100%) developed complications in their management, and 2 (66%) required open surgical intervention. The 1 patient with grade V injury underwent nephrectomy because of hemodynamic instability.

CONCLUSION: Grade IV renal injuries with medial contrast extravasation are associated with urologic intervention at greater rates than those without extravasation. Delayed treatment of this finding could be associated with greater than expected complication rates and renal loss, and early/aggressive treatment should be considered. This knowledge could improve the specificity of "expectant" nonoperative management of pediatric renal injury.