• Judith C Hagedorn, Nicole Fox, Jonathan S Ellison, Robert Russell, Cordelie E Witt, Kristen Zeller, Paula Ferrada, and John M Draus.
• From the Department of Urology (J.C.H.), University of Washington, Seattle, Washington; Division of Pediatric Surgery, Department of Surgery (N.F.), Cooper University, Camden, New Jersey; Children's Hospital of Wisconsin and Medical College of Wisconsin (J.S.E.), Milwaukee, Wisconsin; Department of Surgery (R.R.), Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, Alabama; Department of Surgery (C.E.W.), University of Washington, Seattle, Washington; Department of Surgery (K.Z.), Section of Pediatric Surgery, Wake Forest School of Medicine, Wake Forest, North Carolina; Department of Surgery (P.F.), Virginia Commonwealth University, Richmond, Virginia; and Division of Pediatric Surgery, Department of Surgery (J.M.D.), University of Kentucky, Lexington, Kentucky.
• J Trauma Acute Care Surg. 2019 May 1; 86 (5): 916-925.

BackgroundInjury 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.MethodsGrading of Recommendations Assessment, Development and Evaluation 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 performed. 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.ResultsWhen comparing nonoperative management versus 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 nonoperatively. We found that in pediatric patients with high-grade American Association for the Surgery of Trauma grade III-V (AAST III-V) renal injuries and ongoing bleeding or delayed bleeding, angioembolization has a decreased rate of renal loss compared with surgical intervention. We found the rate of posttraumatic renal hypertension to be 4.2%.ConclusionBased on the completed meta-analyses and Grading of Recommendations Assessment, Development and Evaluation profile, we are making the following recommendations: (1) In pediatric patients with blunt renal trauma of all grades, we strongly recommend nonoperative management versus operative management in hemodynamically stable patients. (2) In hemodynamically stable pediatric patients with high-grade (AAST grade III-V) renal injuries, we strongly recommend angioembolization versus 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.Level Of EvidenceGuidelines study, level III.

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