Pediatric Trauma (Campbell Review 12th Ed Chapter Review) Flashcards
Which pediatric renal trauma grades can be managed non operatively?
The majority of renal trauma can be managed nonoperatively. Grade
4–5 injuries can be managed nonoperatively but have higher risk of
undergoing intervention.
How do you manage persistent or delayed bleeding in grade 3-5 pediatric renal injuries managed non operatively?
Around 25% of patients with grade 3–5 injuries being managed
nonoperatively will have persistent or delayed bleeding.
Superselective angioembolization of bleeding vessels is very
successful and is the preferred method for management. Repeat
angioembolization can also be successful if initial attempt fails.
What percentage of patients with urine leak managed non operatively will have an indication for intervention in pediatric renal trauma? What are the options?
Around 15% of patients with a urine leak being managed
nonoperatively will have indication for intervention such as ureteral
stent placement and/or percutaneous drain placement.
In pediatric grade 1-3 renal injuries managed non operatively, is there a need to do routine repeat imaging?
Repeat CT imaging 48–72 h after injury is not needed for patients
with grade 1–3 injuries who are recovering without complication.
Repeat CT imaging in 48–72 h may be obtained in patients with
grade 4–5 injuries but is of unclear utility if the patient is stable and
recovering without apparent complication.
What are the indications for operative intervention in pediatric renal trauma?
Indications for operative intervention include hemodynamic
instability due to renal bleeding, pulsatile or expanding
retroperitoneal hematoma at time of laparotomy without prior renal
imaging, and failure of angioembolization to control renal bleeding.
When should renal vascular control be done in pediatric renal trauma?
Control of renal vascular should be performed immediately after
opening Gerota fascia or prior to opening Gerota fascia.
What is the dictum in operative intervention regarding nephrectomy in pediatric injuries?
Operative intervention should include attempts to salvage kidney if
possible.
When should you repair pediatric UPJ disruptions?
UPJ disruptions should be repaired in acute phase if patient is stable;
otherwise drainage with nephrostomy tube and possible
percutaneous perirenal drain with delayed repair should be
performed.
How are pediatric renal pelvis ruptures managed?
Renal pelvis ruptures may require operative intervention but have
been managed successfully with endoscopic and percutaneous
urinary drainage.
How high is the risk of renal scarring in high grade renal injuries (grade 4-5)?
The risk of renal scarring is negligible in grade 1–2 injuries, approximately 50% in grade 3 injuries, and 100% in grade 4–5 injuries.
What are the options for follow-up imaging in pediatric grade 3-5 renal injuries?
Follow-up imaging for grade 3–5 injuries should be considered.
Starting with a renal ultrasound and obtaining CT, MRI, or DMSA
scan if necessary is a common approach.
In what grade of injuries can hypertension be seen after pediatric renal trauma?
Hypertension is a rare occurrence after renal trauma in children and
typically is only seen after grade 3–5 injuries.
Is CKD or ESRD common after nephrectomy in pediatric renal trauma?
The development of chronic kidney disease or end-stage renal
disease is very rare after renal trauma even when nephrectomy is
performed.
How do you advise patients with solitary kidneys regarding their participation in contact sports?
Patients with a normal solitary kidney can participate in sports, but
protective equipment is recommended for contact sports. High-risk
activities include dirt bike riding, cycling, and all-terrain vehicle
riding.
Where are ureteral injuries more common? blunt or penetrating trauma?
Ureteral injuries are rare with any type of trauma but are most
commonly seen with penetrating trauma.