title: Management of pediatric blunt renal trauma: A systematic review.
abstract: BACKGROUND
  Blunt trauma remains a significant cause of morbidity and mortality in the pediatric population. The use of conservative management for blunt renal trauma is widely accepted in adult trauma literature and is now increasingly accepted for use in the pediatric patient population. This study aimed to review current practices in pediatric blunt renal trauma management and to highlight current practices in conservative protocols, success rates of conservative management strategies, as well as short- and long-term outcomes of blunt renal trauma management.
  
  
  METHODS
  This is a systematic review of PubMed, Ovid, and the Cochrane Library. The following search was performed in each of the three databases: (Renal or Kidney) AND (Pediatric or Children) AND Trauma AND Management. Publications were limited to publish date after January 1, 2000. Inclusion criteria were (1) original research articles regarding management of pediatric blunt renal trauma, (2) involvement of cases of high-grade renal (Grades IV and V) trauma, and (3) more than one patient presented per study. Literature reviews and meta-analyses were excluded.
  
  
  RESULTS
  Titles and abstracts (n = 308) were screened to identify scientific articles reporting original research findings. A total of 32 articles met the selection criteria and were included in the review.
  
  
  CONCLUSIONS
  The literature supports application of conservative management protocols to high-grade blunt pediatric renal trauma. Criteria for early operative intervention are not well understood. At this time, emergent operative intervention only for hemodynamic instability is recommended. Minimally invasive interventions including angioembolization, stenting, and percutaneous drainage should be used when indicated. Short- and long-term outcomes are favorable when using conservative management approaches to Grade IV and V renal injuries. Further studies including prospective studies and randomized control trials are necessary. Cost analyses of current treatment protocols are also necessary to guide efficient management strategies.
  
  
  METHODS
  Systematic review, level III.
authors.affiliation: From the Department of General Surgery (E.L.V.), Huntington Hospital, Pasadena; Division of Pediatric Surgery (F.C., R.V.B., J.Z., J.S.U.), Children's Hospital Los Angeles; and Keck School of Medicine (R.V.B., J.S.U.), University of Southern California, Los Angeles, California; and Tel Aviv Sourasky Medical Center (O.Z.), Tel Aviv, Israel.
authors.forename: Elyse
authors.initials: E
authors.lastname: LeeVan
authors.forename: Osnat
authors.initials: O
authors.lastname: Zmora
authors.forename: Francesca
authors.initials: F
authors.lastname: Cazzulino
authors.forename: Rita V
authors.initials: RV
authors.lastname: Burke
authors.forename: Jessica
authors.initials: J
authors.lastname: Zagory
authors.forename: Jeffrey Scott
authors.initials: JS
authors.lastname: Upperman
mesh_terms: D002648:Child; D019468:Disease Management; D006801:Humans; D007668:Kidney / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000628:therapy*