43 A SUCCESSFUL PROSPECTIVE TRAIL OF CONSERVATIVE MANAGEMENT FOR PEDIATRIC BLUNT RENAL TRAUMA

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery I1 Apr 201043 A SUCCESSFUL PROSPECTIVE TRAIL OF CONSERVATIVE MANAGEMENT FOR PEDIATRIC BLUNT RENAL TRAUMA Carrie Fitzgerald, Peter Tran, Jeff Burnell, and Richard Santucci Carrie FitzgeraldCarrie Fitzgerald More articles by this author , Peter TranPeter Tran More articles by this author , Jeff BurnellJeff Burnell More articles by this author , and Richard SantucciRichard Santucci More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.088AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Expectant management of hemodynamically stable blunt renal trauma is standard of care in adults. Conservative management of blunt renal trauma is also safe in properly selected pediatric patients. This study prospectively evaluated the safety and efficacy of an ultra conservative blunt renal trauma protocol at a Level 1 pediatric trauma center. METHODS Thirty-nine pediatric patients with blunt renal trauma were identified from 2003 to 2008. An ultra conservative approach was implemented in these consecutively presenting patients. Applied standards were as follows; imaging reserved for patients with gross hematuria, microscopic hematuria with concomitant shock or significant deceleration injury. Non-operative management if hemodynamically stable, responds favorably to < 2 units blood transfusions and imaging doesn't show lesion requiring operating (ureteral injury, Grade V vascular injury). Exploratory laparotomy for non-renal causes did not necessarily warrant renal exploration. Outcomes evaluated were injury grade, hematuria, operative management, length of stay and associated injuries. Study design was based on a successful, published retrospective review of blunt renal management from 1990 to 2002, at the same institution. RESULTS The 39 confirmed cases were assigned American Association for the Surgery of Trauma (AAST) renal injury, grade I (N=13), grade II (N=8), grade III (N=11), grade IV (N=6), grade V (N=1). Ultra conservative management resulted in a 100% renal salvage rate, 38 of 39 (97%) managed non-operatively and 1 of 39 (3%) requiring a delayed renorrhaphy. Prospective findings were comparable to results in retrospective review from 1990-2002. Combining datasets, 1990-2008 (N=100), a 99% renal salvage rate was seen. Mean length of stay (LOS) did not correlate with injury grade. LOS >10 days (N=7, mean 20 days) correlated only with the degree of non-renal injuries (100%), ventilator dependent respiratory failure (57%) and/or non-renal surgical intervention (43%). Salvage rates may reflect limited number of grade 5 blunt renal trauma cases 2003-2008 (N=1), 1990-2002 (N=2). CONCLUSIONS This is the first prospective study of a non-operative protocol for management of blunt pediatric renal trauma, which had been previously seen to be safe in a retrospective study at this same institution. Expectant management of non-exsanguinating pediatric blunt renal trauma is safe and effective. Also, serious renal injuries were not missed by applying adult diagnostic imaging protocols to children. Detroit, MI© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e18 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carrie Fitzgerald More articles by this author Peter Tran More articles by this author Jeff Burnell More articles by this author Richard Santucci More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...