Pathway Background and Objectives

The kidney is the most frequently injured urologic organ, with 70% to 80% being a consequence of blunt trauma. Although few urologic injuries are immediately life-threatening, they do account for some of the more frequent complications of trauma. In the late 1990s, the American Pediatric Surgery Association (APSA) Trauma Committee developed non-operative management guidelines for blunt trauma to the abdomen to help standardize care.

This pathway to help in the management of suspected or confirmed renal injury by doing the following:

  • Standardize care to decrease variability in the management of patients with renal injuries
  • Decrease length of stay to conform with current evidence-based guidelines
  • Decrease unnecessary laboratory testing
  • Avoid unnecessary PICU admissions
  • Clearly delineate discharge criteria

Algorithm  Educational Module

  • Percentage of patients with pathway order set usage
  • Percentage of patients with injury graded by radiologist
  • % patients with delayed CT imaging performed
  • Average time (minutes) arrival to request for Interventional Radiology
  • Average time (minutes) from IR request to procedure (arterial puncture)
  • Average length of stay (days) by grade of injury
  • Graziano KD, Juang D, Notrica D, et al. Prospective observational study with an abbreviated protocol in the management of blunt renal injury in children. J Pediatr Surg. 2014;19(1):198-200; discussion 200-1.
  • LeeVan E, Zmora O, Cazzulino F, et al. Management of pediatric blunt renal trauma: A systematic review. J Trauma Acute Care Surg. 2016;80(3):519-28.
  • Matthews LA, Smith EM, Spirnak JP. Nonoperative treatment of major blunt renal lacerations with urinary extravasation. J Urol. 1997 June;157(6):2056-8.
  • Moore EE, Shackford SR, Pachter HL, et al. Organ injury scaling: spleen, liver, and kidney. J Trauma. Dec 1989;29(12):1664-6.
  • Murphy GP, Gaither TW, Awad MA, et al. Management of Pediatric Grade IV Renal Trauma. Curr Urol Rep. 2017;18(3):23.
  • Williams RF, Grewal H, Jamshidi R, Naik-Mathuria B, Priace M, Russell RT, Vogel A, Notrica DM, Stylianos S, Petty J. Updated APSA Guidelines for the Management of Blunt Liver and Spleen Injuries. J Ped Surgery. 2023 Aug;58(8):1411-1418.
  • Brendan Campbell, MD, MPH
  • Evan Fusaro, PA-C
  • Jen Tabak, RN, MSN

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.