Pediatric emergency medicine trisk 3310 3310
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In the adult population, radiographic evaluation is required in patients
with hypotension, penetrating injuries in the vicinity of urologic organs,
associated abdominal injuries, or the presence of any degree of
hematuria. Criteria regarding the imaging of children with penetrating
trauma are less well established.
Hypotension is not a reliable indicator of significant renal injury in
children and therefore is not used to guide management; however, most
patients with multisystem trauma and hypotension undergo an abdominal
computed tomographic (CT) scan screening that elucidates both
nonurologic and urologic injuries.
Radiographic evaluation of the pediatric genitourinary tract is
necessary in cases with clinical signs indicative of renal injury, gross
hematuria, major associated injuries, or history of significant deceleration
forces. For blunt abdominal trauma, imaging is considered in any stable
child with gross hematuria or significant microscopic hematuria (>50 red
blood cells per high power field) associated with shock (systolic blood
pressure <90 mm Hg). However, the late manifestations of shock in
children with traumatic injuries have led many experts to recommend
imaging in any stable child with microscopic hematuria >50 red blood
cells with or without shock. Additionally, any child with a significant
associated injury or a suspicious mechanism of injury such as a rapid
deceleration, high velocity strike, fall from >15 ft, or a direct blow to the
abdomen or flank should be imaged regardless of the presence of
hematuria. All clinically stable children with penetrating abdominal or
pelvic trauma should undergo radiographic assessment. Stable blunt
trauma patients with microscopic hematuria may be observed without
imaging, unless they suffered a major acceleration or deceleration injury
such as a fall from a great height or high-speed MVC.
