Editorial comment

摘要

What do we know about the need for routine reimaging after renal trauma? In the adult blunt renal trauma population, follow-up computed tomography (CT) scans on asymptomatic patients are not required (their citations 6-8). Less is known about the proper follow up of children with blunt renal trauma. Eeg et al (their citation 9) decreased the number of follow-up CT scans in children with blunt renal trauma to 3%, partly by eliminating imaging in asymptomatic patients and partly by substituting ultrasound.In this adult series, the authors reimaged 69% of their patients: 37% with CT and 30% with ultrasonography. However, these authors found that imaging did not actually help make any new diagnoses in the absence of symptoms such as pain, fever, or elevated white blood count. If imaging had been skipped in asymptomatic patients, they would not be harmed. Those who had no planned imaging, too, did not suffer harm in their series.So, you can skip reimaging in asymptomatic grade I-III blunt renal trauma patients. For grade IV-V injuries, you might also reasonably skip rescanning in those without symptoms (my conclusion, not theirs), or follow the author's guidelines: (1) follow-up ultrasonography in all grade-IV patients, escalating to a CT if it is not diagnostic, (2) follow-up CT in all grade-V injuries. We continue to learn what we do and don't have to do in renal trauma.