Department of Urology, and Department of Epidemiology and Biostatistics (BNB), University of California, San Francisco, San Francisco, California.
Department of Urology, and Department of Epidemiology and Biostatistics (BNB), University of California, San Francisco, San Francisco, California.
J Urol. 2018 Feb;199(2):552-557. doi: 10.1016/j.juro.2017.09.001. Epub 2017 Sep 9.
Efforts have been made to reduce use of computerized tomography in children with blunt abdominal injury. Computerized tomography may be overused in pediatric patients with renal trauma.
We performed a retrospective chart review of all renal trauma patients younger than 18 years old treated at 2 urban trauma centers from 2002 to 2016. We collected demographic and clinical characteristics, renal trauma grades, urological interventions, and timing and use of computerized tomography and renal ultrasound.
During the study period 145 patients presented with blunt renal trauma. During hospitalization 46 patients (32%) underwent repeat computerized tomography. About 20% of repeat computerized tomograms were performed less than 48 hours after the first scan. After controlling for center, isolated injury (yes/no), stent placement, age and surgical interventions (yes/no) patients who underwent delayed imaging on their first scan had decreased odds of undergoing a second computerized tomogram (adjusted OR 0.2, 95% CI 0.05-0.9, p = 0.04). Number needed to treat to prevent 1 repeat scan in high grade renal trauma patients was 3 (95% CI 2-4). Estimated sensitivity and specificity for ultrasound monitoring to detect an abnormality requiring urological intervention are 50% and 94%, respectively.
Repeat computerized tomography in pediatric patients with renal trauma is common. Obtaining delayed imaging on the initial scan in patients with high grade renal trauma may prevent repeat scans. Renal ultrasound provides diagnostic usefulness in monitoring kidney injuries and should be considered before repeating computerized tomography.
人们已经努力减少对钝性腹部损伤儿童使用计算机断层扫描。在小儿肾外伤患者中，计算机断层扫描可能被过度使用。
我们对 2002 年至 2016 年在 2 个城市创伤中心治疗的所有年龄小于 18 岁的肾外伤患者进行了回顾性图表审查。我们收集了人口统计学和临床特征、肾外伤分级、泌尿科干预以及计算机断层扫描和肾脏超声的时间和使用情况。
在研究期间，145 例患者因钝性肾外伤就诊。住院期间，46 例（32%）患者接受了重复计算机断层扫描。大约 20%的重复计算机断层扫描是在第一次扫描后不到 48 小时进行的。在控制中心、孤立伤（是/否）、支架放置、年龄和手术干预（是/否）后，第一次扫描时进行延迟成像的患者进行第二次计算机断层扫描的可能性降低（调整后的 OR 0.2，95%CI 0.05-0.9，p = 0.04）。在高级别肾外伤患者中，预防 1 次重复扫描的治疗需要数为 3（95%CI 2-4）。超声监测检测需要泌尿科干预的异常的估计灵敏度和特异性分别为 50%和 94%。
在小儿肾外伤患者中，重复计算机断层扫描很常见。在高级别肾外伤患者的初始扫描中获得延迟成像可能会预防重复扫描。肾脏超声在监测肾损伤方面具有诊断作用，在重复计算机断层扫描之前应考虑使用。
