Journal article
Renal ultrasound to evaluate for blunt renal trauma in children: A retrospective comparison to contrast enhanced CT imaging
Journal of pediatric urology, Vol.16(5), pp.557.e1-557.e7
10/2020
DOI: 10.1016/j.jpurol.2020.04.020
PMID: 32446678
Abstract
The standard imaging modality for hemodynamically stable blunt abdominal trauma patients is a contrast enhanced CT scan, which is reflected in the current AUA urotrauma guidelines. This comes, however, with radiation exposure and the potential sequalae of IV contrast administration in the pediatric patient.
We hypothesize that ultrasound imaging would be able to diagnose and rule out clinically significant renal injuries when compared to the gold standard of CT scan in the setting of pediatric blunt abdominal trauma.
All children <18 years of age who were evaluated for blunt abdominal trauma who had a CT scan and ultrasound imaging of kidneys were identified. The ultrasound images were reviewed by four reviewers who were blinded to CT results and all clinical information. The ability of ultrasound to diagnose and rule out clinically significant renal injury was evaluated by diagnostic test performance characteristics including sensitivity, specificity, negative predictive value and positive predictive value.
There were 76 patients identified, 24 of which had a renal injury (1 bilateral) diagnosed by CT scan for a total of 25 injuries in 152 renal units. There were six grade I-II injuries and 19 grade III-V injuries. The sensitivity of the four blinded reviewers by ultrasound alone to detect the 19 grade III-V injuries ranged from 79 to 100% with NPV between 97 and 100%. Three of the four reviewers identified all 19 grade III-V injuries by ultrasound. When combined with significant hematuria, all 19 grade III-IV injuries were identified. Of note, all patients with a grade III-V injury of the kidney had significant hematuria. Of the grade I-II renal injuries, all reviewers identified 1/5 or 2/5 by ultrasound alone.
The limitations of this study include: its retrospective nature, limited number of patients and reviewers, quality of the ultrasound machine. and experience of technologist, radiologist and urologist. A major limitation is the inability to assess other solid organ injuries during this initial study.
When compared to a CT scan as the gold standard, kidney ultrasound images had a sensitivity of 79–100% to detect grade III-V injuries and NPV of 97–100% by four blinded reviewers. All grade III-V injuries had either an episode of gross hematuria or microscopic hematuria >50 RBC/hpf. A prospective study that includes full abdominal imaging is needed to confirm that ultrasound can safely be used in place of CT scan for evaluation of hemodynamically stable blunt trauma patients.Summary TablePatient Characteristics (N = 76)Female30 (39%)Age in years (median, IQR)9.4 (6.1–13.5)Number of renal injuries25AAST Grade I-II6AAST Grade III-V19Gross hematuria or >50 RBC/hpf32 (42%)Diagnostic test performance for ultrasound to diagnose and rule out renal trauma for blinded reviewersAll renal traumaSensitivityNPVReviewer 120/25 (80%)121/126 (96%)Reviewer 220/25 (80%)125/130 (96%)Reviewer 316/25 (64%)119/127 (93%)Reviewer 421/25 (84%)119/123 (97%)Grade III-V renal traumaSensitivityNPVReviewer 119/19 (100%)126/126 (100%)Reviewer 219/19 (100%)130/130 (100%)Reviewer 315/19 (79%)124/128 (97%)Reviewer 419/19 (100%)123/123 (100%)IQR = interquartile range; AAST = American Association for the Surgery of Trauma; RBC = red blood cells; hpf = high power field; NPV = negative predictive value; PPV = positive predictive value; ROC AUC = receiver operating characteristic area under curve
Details
- Title: Subtitle
- Renal ultrasound to evaluate for blunt renal trauma in children: A retrospective comparison to contrast enhanced CT imaging
- Creators
- Angelena Edwards - The University of Texas Southwestern Medical CenterMatthew Hammer - The University of Texas Southwestern Medical CenterMaddy Artunduaga - The University of Texas Southwestern Medical CenterCraig Peters - The University of Texas Southwestern Medical CenterMicah Jacobs - The University of Texas Southwestern Medical CenterBruce Schlomer - The University of Texas Southwestern Medical Center
- Resource Type
- Journal article
- Publication Details
- Journal of pediatric urology, Vol.16(5), pp.557.e1-557.e7
- Publisher
- Elsevier Ltd
- DOI
- 10.1016/j.jpurol.2020.04.020
- PMID
- 32446678
- ISSN
- 1477-5131
- eISSN
- 1873-4898
- Language
- English
- Date published
- 10/2020
- Academic Unit
- Stead Family Department of Pediatrics; Urology
- Record Identifier
- 9984319993302771
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