Clinical Indications for Radiographic Evaluation of Blunt Renal Trauma

Cass, Alexander S.; Luxenberg, Michael G.; Gleich, Paul; Smith, Chery

doi:10.1016/s0022-5347(17)44871-3

Cited by 58 publications

(20 citation statements)

References 1 publication

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“…Others have proposed that imaging for adult trauma patients with hematuria is necessary only with gross hematuria or with microscopic hematuria associated with shock, clinical suspicion of abdominal injury, or significant deceleration injury [7]. If the presence of hematuria without associated shock is considered as the only criteria for imaging in the adult patient, then avoiding imaging has been demonstrated to miss cases of severe renal injury [8].…”

Section: Imagingmentioning

confidence: 99%

Review of the evidence on the management of blunt renal trauma in pediatric patients

et al. 2009

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Due to the size and location within the pediatric patient, the kidneys are susceptible to injury from blunt trauma. While it is clear that the goal of management of blunt renal trauma in children is renal preservation, the methods of achieving this goal have not been well established in the current literature. Therefore, we have set out to summarize and clarify the current published information on the management strategies for blunt renal trauma in children. While there is extensive literature available, it consists mostly of retrospective series documenting widely varied management styles. The purpose of this review is to display the current information available and delineate the role for future studies that may allow us to develop consistent management strategies of pediatric patients, who have sustained blunt renal trauma, in a safe and cost-effective manner.

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Section: Imagingmentioning

confidence: 99%

Review of the evidence on the management of blunt renal trauma in pediatric patients

et al. 2009

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“…When there is a strong suspicion of renal injury, correlation with physical examination results and urinalysis may be helpful. 17 If the ultrasonogram is negative for renal parenchymal injury, urinalysis results would seem helpful. In our series, all patients with grade III injuries and seven of nine patients with grade II injuries had urinalysis with 50 RBC/hpf or greater.…”

Section: Discussionmentioning

confidence: 99%

Use of ultrasonography in the patient with acute renal trauma.

McGahan

Richards

Jones

et al. 1999

Journal of Ultrasound in Medicine

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The purpose of this study was to assess the use of emergent ultrasonographic examination in acute traumatic renal injuries. Over a 3 year period, prospective data of all patients who had an emergency ultrasonogram were recorded. Thirty‐two patients with 37 renal injuries were studied retrospectively to identify in how many patients the sonogram detected free fluid or a renal parenchymal abnormality. Free fluid in the abdomen was identified in 19 of 32 patients (59%). However, 12 of these 19 patients had concomitant injury, such as splenic rupture requiring splenectomy, severe liver lacerations, or bowel lacerations requiring repair, that were possible causes of the free fluid. Eliminating these patients, only seven of 20 patients with isolated renal injuries had free fluid in the abdomen (35%), whereas 13 of 20 patients (65%) had no evidence of free fluid. All seven patients with free fluid had moderate or severe renal injuries. Renal parenchymal abnormalities were identified on ultrasonograms in eight of 37 (22%) of injured kidneys. The abnormalities were detected more commonly in cases of severe injury (60%). In conclusion, acute injuries of the kidney from blunt abdominal trauma often are associated with significant splenic, hepatic, or bowel trauma. Isolated renal injuries frequently occur without the presence of free fluid in the abdomen. Furthermore, the ultrasonogram of the kidney often is normal with acute renal injuries, but it is more likely to be abnormal with severe (grade II or greater) renal injuries. Sonography may be used in the triage of patients with blunt abdominal trauma and possible renal injury. However, a negative ultrasonogram does not exclude renal injury, and, depending on clinical and laboratory findings, other imaging procedures such as computed tomography should be performed.

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“…However, the majority of blunt renal injuries are contusions that require no active therapy. 1,[3][4][5]7 Hypotension is often an unreliable predictor of significant renal injury, as children can maintain a normal blood pressure despite extensive blood loss. 6 Traditionally, all children with any degree of microscopic hematuria after blunt trauma have undergone renal imaging.…”

Section: Brandes and Mcaninch: Renal Trauma: Evaluation And Managementmentioning

confidence: 99%

“…Grade 1 renal injuries heal spontaneously without adverse sequelae and thus require no staging or active treatment. [3][4][5] In order to make appropriate management decisions, significant renal injuries (namely, grade 2-5) when possible, should undergo complete radiographic staging. 1 Staging of renal injuries permits selective management based on the extent of renal injury and the patient's clinical status.…”

Section: Imaging Studiesmentioning

confidence: 99%