Radiographic evaluation of adult patients with blunt renal trauma

Recent reports in the literature suggest that radiographic evaluation of the normotensive blunt trauma patient with microscopic hematuria is no longer necessary. Several facilities, however, including ours, continue to perform excretory urography (IVP) routinely in this setting. To evaluate further whether this practice is indicated, we retrospectively reviewed the records of 317 adults who presented to our facility between May 1986 and December 1989 after blunt trauma with resultant microscopic hematuria but no shock. All patients were radiographically assessed with an IVP. Of the 317 studies 29 (9%) had an abnormal result, including 28 with renal contusion and 1 with a nonfunctioning kidney (in which case further evaluation revealed a congenitally absent kidney). No significant urological injury was identified. Thus, no injury would have been missed if a policy of observation had been followed in these patients. Our data support other reports in the literature that radiographic staging is not necessary in the adult blunt trauma patient with microscopic hematuria but no shock.