Objectives To characterize the utilization of delayed phase computed tomography (CT) imaging in blunt renal trauma and determine if the omission of delayed phase CT imaging affected clinical outcomes in children. Methods A prospectively collected trauma database was reviewed between 2006 and 2016 to identify patients ≤21 years of age with a diagnosis of renal injury from blunt trauma. Demographic characteristics, injury grade, injury severity score (ISS), non-kidney organ injuries, radiologic studies, and clinical course were reviewed. Patients were categorized into two groups: those who received CT with delayed images in the emergency room, and those who did not. Results In total 121 patients met inclusion criteria. Delayed scans were obtained in 50 patients (41%) but omitted in 71 (59%). Age, weight, non-kidney organ injuries, and imaging location did not differ between groups. ISS was higher in the no-delay group compared to the delay group (median 16 vs. 10 respectively, p=0.4). Median length of stay (LOS) was 3 days without significant differences by cohort (P=0.24). The proportion of patients who received abdominal CT scans post-admission, underwent a urologic procedure, or were readmitted did not differ significantly between groups. Conclusions This study was unable to demonstrate a difference in outcomes between patients who had a CT with delayed imaging and those who did not. This questions the universal necessity for delayed images after blunt renal trauma. Future prospective studies are necessary to develop pediatric trauma guidelines that balance imaging needs and radiation exposure.
Urology. 2017 Nov 23 [Epub ahead of print]
Molly E Fuchs, Nicholas Beecroft, Daniel G Dajusta, Daryl J McLeod
Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, Ohio., Medical Student Research Program, The OSU College of Medicine, Columbus, Ohio., Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, Ohio. Electronic address: .