Pediatric Blunt Renal Trauma Practice Management Guidelines: Collaboration between the Eastern Association for the Surgery of Trauma and the Pediatric Trauma Society

BACKGROUND Injury to the kidney from either blunt or penetrating trauma is the most common urinary tract injury. Children are at higher risk of renal injury from blunt trauma than adults, but no pediatric renal trauma guidelines have been established. The authors reviewed the literature to guide clinicians in the appropriate methods of management of pediatric renal trauma. METHODS GRADE methodology was used to aid with the development of these evidence based practice management guidelines. A systematic review of the literature including citations published between 1990 and 2016 was done. Fifty one articles were used to inform the statements presented in the guidelines. When possible a meta-analysis with forest plots was created and the evidence was graded. RESULTS When comparing non-operative management vs. operative management in hemodynamically stable pediatric patient with blunt renal trauma, evidence suggests that there is a reduced rate of renal loss and blood transfusion in patients managed non-operatively. We found that in pediatric patients with high grade (AAST III-V) renal injuries and ongoing bleeding or delayed bleeding, angio-embolization has a decreased rate of renal loss compared to surgical intervention. We found the rate of post-traumatic renal hypertension to be 4.2%. CONCLUSIONS Based on the completed meta-analyses and GRADE profile we are making the following recommendations: 1. In pediatric patients with blunt renal trauma of all grades, we strongly recommend non-operative management vs. operative management in hemodynamically stable patients. 2. In hemodynamically stable pediatric patients with high grade (AAST grade III-V) renal injuries, we strongly recommend angio-embolization vs. surgical intervention for ongoing or delayed bleeding. 3. In pediatric patients with renal trauma, we strongly recommend routine blood pressure checks to diagnose hypertension. This review of the literature reveals limitations and the need for additional research on diagnosis and management of pediatric renal trauma. STUDY TYPE Guidelines LEVEL OF EVIDENCE III Corresponding Author: Judith C. Hagedorn, MD, MHS, Assistant Professor, Department of Urology, Harborview Injury Prevention and Research Center (HIPRC) University of Washington Harborview Medical Center, Box 359960, 325 9th Avenue, Seattle, WA 98104. e-mail: judithch@uw.edu. Phone: 206-744-6384, Fax: 206-744-4709 These guidelines were presented at the 31st EAST Annual Scientific Assembly, January 11-15th, 2018 in Lake Buena Vista, FL. No conflict of interest, financial or other exists. © 2019 Lippincott Williams & Wilkins, Inc.

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