Medical Professional Publications

Do Kids Need Delayed Phase CT Imaging After Blunt Renal Trauma?

Columbus, OH — March 2018

With no specific pediatric guidelines for imaging after blunt renal trauma, many pediatric urologists follow adult recommendations from the American Urological Association: a multi-phase computerized tomography (CT) with both cortical and delayed phases with intravenous contrast should be performed. The cortical phase can detect a vascular injury, and the delayed phase detects urine leaks.

Molly Fuchs, MD, a member of the Section of Urology at Nationwide Children’s Hospital, recognized that some renal trauma patients – especially those referred from other institutions -- had only received cortical phase CT scans. Should urologists then ask for additional scanning, exposing patients to additional radiation, or is expectant management sufficient?

A recent study led by Dr. Fuchs found no difference in outcomes between children who had delayed phase CT scans and those who did not.

“We are not questioning the guidelines; if patients come in through the Emergency Department at Nationwide Children’s with blunt renal trauma, it is appropriate for them to receive full phase CT,” says Dr. Fuchs. “If delayed imaging hasn’t been done when they present to us, however, we question the utility of repeating the CT scan to attain delayed imaging, particularly when the child is clinically doing well.  We want to mindful of the recent emphasis on exposing children to radiation doses that are as low as reasonably achievable (ALARA).”  

Dr. Fuchs and her co-authors retrospectively reviewed the records of 121 patients who were diagnosed with renal trauma from blunt injury. Delayed phase scans had been obtained in only 50, or 41 percent, of those patients. The median Injury Severity Score was actually higher in patients who did not have delayed phase scans.

Outcomes, measured by hospital length of stay, patients who received abdominal CT scans after admission, patients who required urologic procedures and readmission did not differ between patients who had delayed phase scans and those who did not.

“We know that many children, even with high-grade renal injuries, recover very well. The clinical course, not the CT findings, typically dictates if a child needs urologic procedures with a stent or a drain,“ says Dr. Fuchs, who is also an assistant clinical professor of Surgery at The Ohio State University College of Medicine. “If no delayed phase CT has been obtained but the child is clinically doing well, our study suggests that it may not be necessary to reflexively perform more imaging unless indicated by the child’s clinical status.”

“This was a retrospective study, and the lack of difference in outcomes should not change our management,” Dr. Fuchs adds. “But it should prompt more investigation into the clinical indications and development of a protocol for multi-phase imaging in pediatric trauma”. 


Fuchs ME, Beecroft N, Dajusta DG, McLeod DJ. Is delayed phase computed tomography imaging necessary after blunt renal trauma in children? Urology. 2017 Nov 23. [Epub ahead of print]

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