Investigating microscopic haematuria in blunt abdominal trauma
Date First Published:
March 1, 2000
Last Updated:
July 9, 2002
Report by:
Fiona Saunders, Specialist Registrar (Manchester STEM)
Search checked by:
Jon Argall, Manchester STEM
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.
Search Details:
[exp hematuria OR hematuria.mp] AND microscopic.mp AND trauma$.mp
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):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Hematuria after blunt trauma: when is pyelography useful? Guice K, Oldham K, et al. 1983, USA | 156 patients having IVP for haematuria following trauma |
Retrospective diagnostic cohort study | Number with significant isolated renal injury | 0/123 patients with microscopic haematuria | Prescence of shock or other injuries not addressed Includes children |
| Renal trauma:re-evaluation of the indications for radiographic assessment. Nicolaisen GS, McAninch JW, et al. 1985, USA | 306 patients with blunt renal trauma |
Prospective diagnostic cohort study | Number with significant isolated renal injury | 0/221 patients with blunt trauma, microscopic haematuria and no shock | Includes children |
| Emergency intravenous pyelography in the trauma patient. A reexamination of the indications. Fortune JB, Brahme J, et al. 1985, USA | 195 patients having IVP following blunt trauma |
Retrospective diagnostic cohort study | Number with significant isolated renal injury | 0/116 patients with microscopic haematuria | |
| Indications for emergency intravenous pyelography in blunt abdominal trauma: a reappraisal. Kisa E, Schenk WG. 1986, USA | 50 patients having IVP for blunt abdominal trauma | Retrospective diagnostic cohort study | Number with significant isolated renal injury | 0/43 patients with microscopic haematuria | Advocate imaging for patients whose microscopic haematuria does not resolve in 24 hours - ? rationale for this |
| Clinical indications for radiographic evaluation of blunt renal trauma. Cass AS, Luxenberg M, et al. 1986, USA | 831 patients with haematuria following blunt trauma |
Retrospective diagnostic cohort study | Number with significant isolated renal injury | 1/494 patients with microscopic haematuria and no shock, one had severe renal injury, with no associated intra-abdominal injuries | |
| Blunt urinary tract trauma: identifying those patients who require radiological diagnostic studies. Hardeman SW, Husmann DA, et al. 1987, USA | 506 patients with blunt trauma and haematuria | Prospective diagnostic cohort study | Number with significant isolated renal injury | 0/365 with microscopic haematuria | |
| Microscopic haematuria after blunt trauma. Is pyelography necessary? Thomason RB, Julian JS, et al. 1989, USA | 102 patients undergoing IVP after blunt trauma | Retrospective diagnostic cohort study | Number with significant isolated renal injury | 0/76 patients with microscopic haematuria | |
| Radiographic evaluation of adult patients with blunt renal trauma. Eastham JA, Wilson TG, et al. 1992, USA | 317 patients with blunt trauma, microscopic haematuria and no shock | Retrospective diagnostic cohort study | Number with significant isolated renal injury | 0/28 patients with renal contusions | |
| Radiographic evaluation of renal trauma: evaluation of 1103 consecutive patients. McAndrew JD, Corriere JN Jr. 1994, USA | 1103 patients undergoing radiographic evaluation of the renal tract for suspected renal trauma | Retrospective diagnostic cohort study | Number with significant isolated renal injury | 1/605 patients with blunt trauma, microscopic haematuria and no shock -1 had significant renal injury, but also associated lethal head injury | |
| The role of haematuria in the diagnosis of blunt trauma. Moller CM, Mommsen S, et al. 1995, Denmark | 114 patients suspected of having renal trauma |
Retrospective diagnostic cohort study | Number with significant isolated renal injury | 0/65 patients with microscopic haematuria ury | Includes children |
Author Commentary:
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.
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:
- Guice K, Oldham K, et al.. Hematuria after blunt trauma: when is pyelography useful?
- Nicolaisen GS, McAninch JW, et al.. Renal trauma:re-evaluation of the indications for radiographic assessment.
- Fortune JB, Brahme J, et al.. Emergency intravenous pyelography in the trauma patient. A reexamination of the indications.
- Kisa E, Schenk WG.. Indications for emergency intravenous pyelography in blunt abdominal trauma: a reappraisal.
- Cass AS, Luxenberg M, et al.. Clinical indications for radiographic evaluation of blunt renal trauma.
- Hardeman SW, Husmann DA, et al.. Blunt urinary tract trauma: identifying those patients who require radiological diagnostic studies.
- Thomason RB, Julian JS, et al.. Microscopic haematuria after blunt trauma. Is pyelography necessary?
- Eastham JA, Wilson TG, et al.. Radiographic evaluation of adult patients with blunt renal trauma.
- McAndrew JD, Corriere JN Jr.. Radiographic evaluation of renal trauma: evaluation of 1103 consecutive patients.
- Moller CM, Mommsen S, et al.. The role of haematuria in the diagnosis of blunt trauma.