Variation in Management of Pediatric Post-traumatic Urine Leaks
Bethany J. Farr, MD; Lindsey B. Armstrong, MD, MPH; Samuel C. Barnett, MD; David P. Mooney, MD, MPH Boston Children's Hospital, Boston, MA
Background:
High-grade renal trauma may be associated with a urine leak and appropriate management remains unclear.
Methods:
Data on patients with a traumatic urine leak were retrieved from the trauma registry and data warehouse of a pediatric level-1 trauma center over a 15-year period. Demographics, diagnoses, imaging, interventions performed and follow-up information were analyzed.
Results:
187 renal injuries were identified and 32 (17%) were high grade. There were 21 (11%) diagnoses of urine leak, comprising the study population. Leaks were identified 0-10 days post-injury. All patients underwent initial CT, however 10 (48%) lacked excretory-phase imaging, leading to repeat CT. Ten patients (48%) did not undergo an intervention for the leak, 11 (52%) underwent at least one, most commonly stent placement (9). ISS and initial Shock Index Pediatric Adjusted were similar between the groups. Two patients underwent definitive operation: ureterocalicostomy (1) and delayed nephrectomy (1). There was wide variation in the use of antibiotic prophylaxis, imaging studies performed and length of hospital stay (See table 1).
Conclusion:
Traumatic renal urine leaks are unusual and half require no intervention. Management is variable and the development of care guidelines could decrease variation, but would likely require a multi-institutional study to generate sufficient patient volume. 
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