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Investigating microscopic haematuria in blunt abdominal trauma

Three Part Question

[In adults with microscopic haematuria following blunt abdominal trauma] is [radiological imaging necessary] to [identify clinically significant renal injury]?

Clinical Scenario

A patient presents to the emergency department following a road traffic accident. He is found to have loin pain and tenderness and microscopic haematuria on dipstick testing. He is not hypotensive and has no other major injuries. You wonder whether radiological imaging is necessary to exclude significant injury to the renal tract?

Search Strategy

Medline 1966-04/02 using the OVID interface, Embase 1988-04/02.
[exp hematuria OR hematuria.mp] AND microscopic.mp AND trauma$.mp

Search Outcome

237 publications identified, 15 of these have direct relevance to the three part question. A further 2 relevant papers were referenced in these. Of these 17 papers 10 are of sufficient quality for inclusion.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Guice K et al,
1983,
USA
156 patients having IVP for haematuria following trauma Retrospective diagnostic cohort studyNumber with significant isolated renal injury0/123 patients with microscopic haematuriaPrescence of shock or other injuries not addressed Includes children
Nicolaisen GS et al,
1985,
USA
306 patients with blunt renal trauma Prospective diagnostic cohort studyNumber with significant isolated renal injury0/221 patients with blunt trauma, microscopic haematuria and no shockIncludes children
Fortune JB et al,
1985,
USA
195 patients having IVP following blunt trauma Retrospective diagnostic cohort studyNumber with significant isolated renal injury0/116 patients with microscopic haematuria
Kisa E et al,
1986,
USA
50 patients having IVP for blunt abdominal traumaRetrospective diagnostic cohort studyNumber with significant isolated renal injury0/43 patients with microscopic haematuriaAdvocate imaging for patients whose microscopic haematuria does not resolve in 24 hours - ? rationale for this
Cass AS et al,
1986,
USA
831 patients with haematuria following blunt trauma Retrospective diagnostic cohort studyNumber with significant isolated renal injury1/494 patients with microscopic haematuria and no shock, one had severe renal injury, with no associated intra-abdominal injuries
Hardeman SW et al,
1987,
USA
506 patients with blunt trauma and haematuriaProspective diagnostic cohort studyNumber with significant isolated renal injury0/365 with microscopic haematuria
Thomason RB et al,
1989,
USA
102 patients undergoing IVP after blunt traumaRetrospective diagnostic cohort studyNumber with significant isolated renal injury0/76 patients with microscopic haematuria
Eastham JA et al,
1992,
USA
317 patients with blunt trauma, microscopic haematuria and no shockRetrospective diagnostic cohort studyNumber with significant isolated renal injury0/28 patients with renal contusions
McAndrew JD et al,
1994,
USA
1103 patients undergoing radiographic evaluation of the renal tract for suspected renal traumaRetrospective diagnostic cohort studyNumber with significant isolated renal injury1/605 patients with blunt trauma, microscopic haematuria and no shock -1 had significant renal injury, but also associated lethal head injury
Moller CM et al,
1995,
Denmark
114 patients suspected of having renal trauma Retrospective diagnostic cohort studyNumber with significant isolated renal injury0/65 patients with microscopic haematuria uryIncludes children

Comment(s)

Numerous retrospective and prospective diagnostic cohort studies attempt to answer the same question. Many are of a high standard and large size. Only those in which the whole cohort underwent diagnostic imaging have been included. Most measured the same variables and used comparable definitions of significant renal injury. Combining the data from the included studies there are 2302 cases of microscopic haematuria following blunt abdominal trauma, in patients who were not shocked and had no major associated injuries. Of these 1 had a clinically significant renal injury.

Clinical Bottom Line

Radiological imaging of the renal tract is not indicated in adults with microscopic haematuria following blunt abdominal trauma, provided they are not shocked and have no major associated injuries.

References

  1. Guice K, Oldham K, et al. Hematuria after blunt trauma: when is pyelography useful? J Trauma 1983;23(4):305-11.
  2. Nicolaisen GS, McAninch JW, et al. Renal trauma:re-evaluation of the indications for radiographic assessment. J Urol 1985;133(2):183-7.
  3. Fortune JB, Brahme J, et al. Emergency intravenous pyelography in the trauma patient. A reexamination of the indications. Arch Surg 1985;120(9):1056-9.
  4. Kisa E, Schenk WG. Indications for emergency intravenous pyelography in blunt abdominal trauma: a reappraisal. J Trauma 1986;26(12):1086-89.
  5. Cass AS, Luxenberg M, et al. Clinical indications for radiographic evaluation of blunt renal trauma. J Urol 1986;136(2):370-1.
  6. Hardeman SW, Husmann DA, et al. Blunt urinary tract trauma: identifying those patients who require radiological diagnostic studies. J Urol 1987;138(1):99-101.
  7. Thomason RB, Julian JS, et al. Microscopic haematuria after blunt trauma. Is pyelography necessary? Am Surg 1989;55(3):145-50.
  8. Eastham JA, Wilson TG, et al. Radiographic evaluation of adult patients with blunt renal trauma. J Urol 1992;148(2 Pt 1):266-7.
  9. McAndrew JD, Corriere JN Jr. Radiographic evaluation of renal trauma: evaluation of 1103 consecutive patients. Br J Urol 1994;73(4):352-4.
  10. Moller CM, Mommsen S, et al. The role of haematuria in the diagnosis of blunt trauma. Scand J Urol Nephrol 1995;172:99-101.