Use of intravenous pyelography in blunt trauma--a reappraisal

The role of intravenous pyelography (IVP) in the evaluation of blunt abdominal trauma is controversial. Major renal injuries have occasionally been reported in the absence of hematuria, but the test is not always accurate, is expensive and has potential morbidity. By reviewing the charts of 150 consecutive patients seen in an emergency department who had IVP for blunt abdominal trauma, we evaluated the ability of clinical and laboratory findings to predict IVP findings, the incidence of abnormal findings on IVP and the number of times IVP affected patient management. Only one patient's management was found to be clearly affected by the results of the IVP. We feel, therefore, that IVP should be reserved in cases of blunt abdominal trauma for patients with gross hematuria and those with microscopic hematuria and suggestive clinical findings. The absence of hematuria should preclude the use of IVP unless there are other exceedingly strong clinical findings.