Browse > Article

Indications for Computed Tomography (CT) to Detect Renal Injury in Pediatric Blunt Abdominal Trauma Patients with Microscopic Hematuria  

Go, Cheol-Gon (Department of Emergency Medicine, Inje University, Sanggye Paik Hospital)
Kim, Hye-Jin (Department of Emergency Medicine, Inje University, Sanggye Paik Hospital)
Cho, Suk-Jin (Department of Emergency Medicine, Inje University, Sanggye Paik Hospital)
Oh, Sung-Chan (Department of Emergency Medicine, Inje University, Sanggye Paik Hospital)
Lee, Sang-Lae (Department of Emergency Medicine, Inje University, Sanggye Paik Hospital)
Ryu, Seok-Yong (Department of Emergency Medicine, Inje University, Sanggye Paik Hospital)
Publication Information
Journal of Trauma and Injury / v.23, no.1, 2010 , pp. 29-37 More about this Journal
Abstract
Purpose: Controversy exists regarding whether pediatric blunt abdominal trauma patients with microscopic hematuria should undergo radiographic evaluation. Adult patients have indications such as shock and deceleration injury. This study was conducted to suggest indications for the use of CT to detect significant renal injury in pediatric blunt abdominal trauma patients with microscopic hematuria. Methods: From January 2005 to December 2009, patients less than 18 years of age with blunt abdominal trauma and microscopic hematuria who had undergone CT were included in this retrospective study. We analyzed the correlation between microscopic hematuria, shock, deceleration injury, and American Association for the Surgery of Trauma (AAST) renal injury grade. Patients were divided into two groups: the insignificant renal injury group (AAST grade 1) and the significant renal injury group (AAST grades 2-5). We compared age, gender, mechanism of injury, degree of microscopic hematuria, evidence of shock, presence of deceleration injury, and associated injuries between the two groups. We analyzed the effect of each of the above each factors on renal injury by using a logistic regression analysis. Results: Forty-three children were included, and the median age was 15 years. Five children had a significant renal injury. No significant differences, except age and microscopic hematuria (more than 30 red blood cells per high power field (RBC/HPF), p = 0.005) existed between the insignificant and the significant injury groups. A positive correlation existed between renal injury and microscopic hematuria (rho = 0.406, p = 0.007), but renal injury was not correlated with shock and deceleration injury. In the multivariate regression analysis, microscopic hematuria was the only factor correlated with renal injury (p = 0.042). Conclusion: If a microscopic hematuria of more than 30 RBC/HPF exists, the use of CT should be considerd, regardless of shock and deceleration injury to detect significant renal injury in pediatric blunt abdominal trauma patients.
Keywords
Child; Computed tomography; Kidney; Hematuria;
Citations & Related Records
Times Cited By KSCI : 2  (Citation Analysis)
연도 인용수 순위
1 Liu M, Lee CH, P'eng FK. Prospective comparison of diagnostic peritoneal lavage, computed tomographic scanning, and ultrasonography for the diagnosis of blunt abdominal trauma. J Trauma 1993;35:267-70.   DOI   ScienceOn
2 Perez-Brayfield RM, Gatti MJ, Smith AE, Broecker B, Massad C, Kirsc JHSA. Blunt traumatic hematuria in children. Is a simplified algorithm justified? J Urol 2002;167:2543-7.   DOI   ScienceOn
3 Mellis P. The normal child. In: Tintinalli EJ, Kelen DG, Stapczynski SKelen DG eds. Emergency medicine, 6th ed. New York: McGrawHill; 2004: 727-31.
4 Cohen J. Differences between correlation coeffecients. In: Cohen J eds. Statistical power analysis for the behavioral sciences, 2th ed. New Jersey: Lawrence Erlbaum; 1988: 110-38.
5 Hashmi A, Klassen T. Correlation between urinalysis and intravenous pyelography in pediatric abdominal trauma. J Emerg Med 1995;13:255-8.   DOI   ScienceOn
6 Carroll P, McAninch J. Operative indications in penetrating renal trauma. J Trauma 1985;25:587-93.   DOI   ScienceOn
7 Karp MP, Jewett Jr TC, Kuhn JP, Allen JE, Dokler ML, Cooney DR. The impact of computed tomography scanning on the child with renal trauma. J Pediatr Surg 1986;21:617-23.   DOI   ScienceOn
8 Quinlan D, Gearhart J. Blunt renal trauma in childhood, features indicating severe injury. BJU Int 1990;66:526-31.   DOI   ScienceOn
9 Herschorn S, Radomski SB, Shoskes DA, Mahoney J, Hirshberg E, Klotz L. Evaluation and treatment of blunt renal trauma. J Urol 1991;146:274-6.   DOI
10 Abou-Jaoude W, Sugarman J, Fallat M, Casale AJ. Indicators of genitourinary tract injury or anomaly in cases of pediatric blunt trauma. J Pediatr Surg 1996;31:86-9.   DOI   ScienceOn
11 Moore EE, Shackford SR, Pachter HL, McAninch JW, Browner BD, Champion HR, et al. Organ injury scaling: spleen, liver, and kidney. J Trauma 1989;29:1664-6.   DOI   ScienceOn
12 Brown LS, Hass C, Dinchman HK, Elder SJ, Spirnak JP. Radiologic evaluation of pediatric blunt renal trauma in patients with microscopic hematuria. World J Surg 2001;25:1557-60.   DOI
13 Santucci AR, Langenburg ES, Zacharea JM. Traumatic hematuria in children can be evaluated as in adults. J Urol 2004;171:822-5.   DOI   ScienceOn
14 Morey FA, Bruce EJ, McAninch WJ. Efficacy of radiographic imaging in pediatric blunt renal trauma. J Urol 1996;156:2014-8.   DOI   ScienceOn
15 Hauda II EW. Pediatric trauma. In: Tintinalli EJ, Kelen DG, Stapczynski SKelen DG eds. Emergency medicine, 6th ed. New York: McGrawHill; 2004: 1542-9.
16 Kelen DG. Genitourinary trauma. In: Tintinalli EJ, Kelen DG, Stapczynski SKelen DG eds. Emergency medicine, 6th ed. New York: McGrawHill; 2004: 1622-9.
17 Ahn J, Morey A, McAninch J. Workup and management of traumatic hematuria. Emerg Med Clin North Am 1998;16:145-64.   DOI   ScienceOn
18 Shin BM. The comparison of microscopic urine sediment, nitrite, and leukocyte esterase tests for bacteriuria. Infect Chemother. 2004;36:92-9.
19 Mendez R. Renal trauma. J Urol 1977;118:698-703.   DOI
20 McAninch JW, Carroll PR, Klosterman PW, Dixon CM,Greenblatt CM. Renal reconstruction after injury. J Urol 1991;145:932-7.   DOI
21 Kuzmarov IW, Morehouse DD, Gibson S. Blunt renal trauma in the pediatric population: a retrospective study. J Urol 1981;126:648-9.   DOI
22 Santucci RA, McAninch JW, Safir M. Validation of the American Association for the Surgery of Trauma organ injury severity scale for the kidney. J Trauma 2001;50:195-200.   DOI   ScienceOn
23 Mee SL, McAninch JW, Robinson AL, Auerbach PS,Carroll PR. Radiographic assessment of renal trauma: a 10-year prospective study of patient selection. J Urol 1989;141:1095-8.   DOI
24 Miller KS, McAninch JW. Radiographic assessment of renal trauma:our 15-year experience. J Urol 1995;154:352-5.   DOI   ScienceOn
25 McAndrew JD, Corriere Jr JN. Radiographic evaluation of renal trauma: evaluation of 1103 consecutive patients. BJU Int 1994;73:352-354.   DOI   ScienceOn
26 Davis JJ, Cohn I, Nance FC. Diagnosis and management of blunt abdominal trauma. Ann Surg 1976;183:672-7.   DOI   ScienceOn
27 Medica J, Caldamone A. Pediatric renal trauma: special considerations. Semin Urol 1995;13:73-6.
28 Stein JP, Kaji DM, Eastham J, Freeman JA, Esrig D, Hardy BE. Blunt renal trauma in the pediatric population: indications for radiographic evaluation. Urology 1994;44:406-10.   DOI   ScienceOn
29 Hwang JY, Cho HS, Park JS. A Clinical Stduy of Abdominal Trauma. J Korean Surg Sci 1989;37:240-8.
30 Chung TK, Hyun SY, Kim JJ, Ryoo E, Lee K, Cho JS, et al. Clinical Investigation of Pediatric Blunt Thoracic Trauma. J Korean Soc Traumatol 2005;18:119-26.