R. Sola1, T. A. Oyetunji1, K. D. Graziano2, S. D. St. Peter1 1Children’s Mercy Hospital- University Of Missouri Kansas City,Surgery,Kansas City, MO, USA 2University Of Arizona,College Of Medicine/ Department Of Surgery,Phoenix, AZ, USA
Introduction: Published prospective observational data suggest children with blunt renal injury can be managed without bedrest, the use of catheters or antibiotics, and follow up imaging can be reserved to those with urinary extravasation. We wanted to investigate the current practice patterns of major children’s’ hospital to identify variation and areas for improvement with the use of evidence based protocols.
Methods: Data from 2006 to 2015 were requested from the Pediatric Health Information System. Patients were included based on the International Classification of Disease Ninth Revision (ICD-9) coding for blunt renal injury. Children were excluded if they had concomitant major thoracic or abdominal injury, diagnosis of renal injury without computerized tomography (CT) imaging confirmation, length of stay greater than seven days, underwent laparotomy and those that were intubated. Demographics, need for further imaging, and hospital outcomes were analyzed.
Results: During the study period, 1487 children were found to have a blunt renal injury. A total of 638 children were identified after excluding those that did not meet our inclusion criteria. Median age was 12 years old (8,14). There were 474 (74%) males and 386 (61%) were white. Median length of stay was 3 days (2,4). Foley catheters were placed in 93 (15%) children and 157 (25%) were given antibiotics during their hospital course. Two or more CT scans were performed in 376 (59%) children during their hospitalization.
Conclusion: Children with blunt renal injury appear to be utilizing excess healthcare resources compared to published recommendations. Further studies implementing an evidence based protocol would allow for the reduction of Foley catheters, antibiotics and CT scans.