Nonoperative Management of Nonvascular Grade IV Blunt Renal Trauma in Children: Meta-analysis and Systematic Review

Objectives: To evaluate nonoperative management of grade IV blunt renal trauma in pediatric patients by performing a systematic review and meta-analysis of published studies. Methods: MEDLINE, EMBASE, Cochrane, and Scopus databases were searched between January 1992 and June 2008 for studies of pediatric renal trauma management. Inclusion criteria were patient age ≤ 18 years and use of the American Association for the Surgery of Trauma renal injury scale. Results: A total of 95 children with grade IV injuries were identified. No intervention was required in 72% (68/95). Hemodynamic instability necessitated surgical exploration in 11% of patients (11/95). Of these, 46% (5/11) required a partial nephrectomy, 27% (3/11) underwent nephrectomy, and 27% (3/11) were salvaged. Angiographic infarction was not used for patients with delayed or persistent hemorrhage. Symptomatic urinoma developed in 17% (16/95). Of these patients, 81% (13/16) were successfully managed by percutaneous drainage or ureteral stent placement, and open intervention to manage complications became necessary in the remaining 19% (3/16). Partial renal preservation was possible in 95% of patients (90/95). Conclusions: Nonoperative management of children with grade IV blunt renal injuries is highly successful, with at least partial renal preservation possible in 95% (90/95) of patients.