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Emergency excretory urography in blunt abdominal trauma
B E Burbridge1, G Groot, F F Oleniuk
1Department of Medical Imaging, Royal University Hospital, Saskatoon, SK.
Summary
Microscopic hematuria in patients with minor blunt abdominal trauma rarely indicates significant renal injury. Routine excretory urography is not recommended for these cases.
Area of Science:
- Urology
- Trauma Surgery
- Diagnostic Imaging
Background:
- Blunt abdominal trauma can cause renal injuries.
- Microscopic hematuria is a common finding after trauma.
- The necessity of excretory urography in these cases is debated.
Purpose of the Study:
- To correlate the degree of hematuria and blunt abdominal trauma with excretory urography findings.
- To determine if microscopic hematuria warrants routine excretory urography in blunt abdominal trauma.
Main Methods:
- Prospective study of 37 patients with blunt abdominal trauma and microscopic hematuria.
- Correlation of erythrocyte counts (per high-power field) with trauma severity and renal injury.
- Excretory urography performed for all patients.
Main Results:
- In minor trauma (17 patients), only 1 of 3 with >50 erythrocytes/hpf had significant injury; none with <50 erythrocytes/hpf did.
- In major trauma (20 patients), 5 had significant renal injury.
- Microscopic hematuria without shock or major injury did not predict significant renal injury.
Conclusions:
- Microscopic hematuria alone in blunt abdominal trauma without shock or major nongenitourinary injury does not necessitate routine excretory urography.
- Selective use of urography may be considered based on trauma severity and erythrocyte count.
- Further research could refine criteria for imaging in trauma patients.