Objectives: To determine if patient variables were associated with intervention in pediatric patients presenting with high-grade renal injuries.

Methods: A retrospective review of pediatric patients presenting with grade IV/V renal injury between 2003 and 2021 at a Level 1 trauma center was performed. Renal injury grade was verified and updated based upon the 2018 American Association for the Surgery of Trauma injury scale. Multivariable logistic regression analyses were performed.

Results: Seventy-five patients (median age 13 years old, IQR 9-16) with Grade IV (n = 53) or Grade V (n = 22) injury were identified. 33% (25/75) had immediate renal intervention within 24 h of admission. Of the remaining 50 children who were observed, 47 had blunt trauma, and outcomes were analyzed. The median age of observed patients was 12 years (IQR 8-14) and 30% (14/47) had intervention. Delayed images on CT showed ureteral contrast was present in 87% (41/47) of observed patients. Multivariable analysis demonstrated that the presence of contrast in the ureter is associated with significantly lower odds of intervention, OR 0.06 [0-0.73, 95% CI], p = 0.03.

Conclusion: After grades IV and V blunt renal injury, for those children who are considered safe to observe, AAST grade of injury did not associate with procedural intervention. The presence of contrast in the ureter on delayed CT imaging was associated with a significantly lower odds of procedural intervention.