Special Considerations

RAPID DECELERATION FORCES Rapid deceleration injuries may result in renal pedicle and vascular injuries. Such injuries result in high mortality rates, but fortunately they are quite rare, occurring in less than 1 percent of blunt renal trauma. However, hematuria, the clue to renal injury, may not be present. Accordingly, patients whose mechanism of injury is from forces of rapid deceleration should have a renovascular imaging study. Since pedicle injuries virtually always occur in association with other significant injuries,5 other indications for radiographic evaluation are likely. Many such patients have other indications for surgical exploration.

PEDIATRIC BLUNT TRAUMA Hematuria following blunt trauma may have different significance in the pediatric population. 67 Unlike the situation in adults, the degree of hematuria does seem to correlate with the degree of injury.5 Many advocate that pediatric patients with any degree of hematuria, even if hemodynamically stable, should undergo imaging studies.89 However, pediatric patients with less than 50 RBCs/hpf do not appear to have significant injuries. 5 Thus, it appears appropriate to perform imaging studies on only those patients with significant hematuria, as defined above. 3 Other standards for imaging studies for pediatric patients remain similar to those for adults.

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