University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
Department of Urology, University of Washington, 1959 NE Pacific Street., Seattle, WA, 98195, USA.
J Pediatr Urol. 2022 Feb;18(1):76.e1-76.e8. doi: 10.1016/j.jpurol.2021.11.005. Epub 2021 Nov 16.
AUA Urotrauma guidelines for renal injury recommend initial nonoperative management followed by repeat CT imaging for stable patients with deep lacerations or clinical signs of complications. Particularly in pediatric patients where caution is taken to limit radiation exposure, it is not known whether routine repeat imaging affects clinical outcomes.
Our objective was to determine whether routine repeat imaging is associated with urologic intervention or complications in nonoperatively managed pediatric renal trauma.
We retrospectively analyzed 337 pediatric patients with blunt and penetrating renal trauma from a prospectively collected database from 2005 to 2019 at a Level I trauma center. Exclusion criteria included age >18 years old, death during admission (N = 39), immediate operative intervention (N = 28), and low-grade renal injury (AAST grades I-II, N = 91). Routine repeat imaging was defined as reimaging in asymptomatic patients within 72 h of initial injury. Patients were placed into three imaging groups consisting of: (A) those with routine repeat imaging, (B) those reimaged for symptoms, or (C) those not reimaged. Comparisons were made using logistic regression controlling for grade of renal injury.
Of the included 179 children, 44 (25%) underwent routine repeat imaging, 20 (11%) were reimaged for symptoms, and 115 patients (64%) were managed without reimaging. Compared to patients who were reimaged for symptoms, asymptomatic patients in the routine repeat imaging group and without reimaging group were significantly less likely to develop a complication (16% and 7% vs. 55%, p < 0.001) or require delayed urologic procedure (5% and 1% vs. 25%, p = 0.007). Comparing the routine repeat imaging group to those without reimaging, we found no difference in complications (p = 0.47), readmissions (p = 0.75), or urologic interventions (p = 0.50).
Despite suffering high-grade (III-IV) renal injuries, the majority of pediatric patients who remained asymptomatic during the first three days of hospitalization did not require a urologic intervention. Foregoing repeat imaging was not associated with a higher rate of complications or delayed procedures, supporting that routine repeat imaging may expose these children to unnecessary radiation and may be avoidable in the absence of signs or symptoms of concern.
AUA 尿外伤指南建议对深度裂伤或有并发症临床体征的稳定患者进行初始非手术治疗，然后重复 CT 成像。特别是在儿科患者中，需要谨慎限制辐射暴露，目前尚不清楚常规重复成像是否会影响临床结果。
我们的目的是确定在非手术治疗的儿童肾外伤中，常规重复成像是否与泌尿科干预或并发症相关。
我们回顾性分析了 2005 年至 2019 年期间在一家一级创伤中心从前瞻性收集的数据库中筛选出的 337 例钝性和穿透性肾外伤的儿科患者。排除标准包括年龄>18 岁（N=39）、住院期间死亡（N=39）、立即手术干预（N=28）和低级别肾损伤（AAST 分级 I-II，N=91）。常规重复成像的定义是在初始损伤后 72 小时内对无症状患者进行再次成像。患者分为三组：（A）进行常规重复成像的患者；（B）因症状而再次成像的患者；（C）未再次成像的患者。使用逻辑回归比较各组，并控制肾损伤程度。
在纳入的 179 名儿童中，44 名（25%）接受了常规重复成像，20 名（11%）因症状而再次成像，115 名（64%）未再次成像。与因症状而再次成像的患者相比，常规重复成像组和未再次成像组的无症状患者发生并发症（16%和 7% vs. 55%，p<0.001）或需要延迟泌尿科手术（5%和 1% vs. 25%，p=0.007）的可能性显著降低。将常规重复成像组与未再次成像组进行比较，我们发现两组在并发症（p=0.47）、再入院（p=0.75）或泌尿科干预（p=0.50）方面无差异。
尽管患有高级别（III-IV）肾损伤，但在住院前三天保持无症状的大多数儿科患者不需要进行泌尿科干预。避免重复成像不会导致更高的并发症或延迟治疗的发生率，这支持在没有关注的迹象或症状的情况下，常规重复成像可能会使这些儿童暴露于不必要的辐射，并且可能是可以避免的。
