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Abstract
A short cut review was carried out to establish whether it is necessary to carry out further imaging in order to identify clinically significant renal injury in patients with microscopic haematuria after blunt abdominal trauma. Altogether 57 papers were found using the reported search, of which 10 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
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Report by Fiona Saunders,Specialist Registrar Search checked by Jon Argall, Senior Clinical Fellow
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?
Three part question
[In adults with microscopic haematuria after blunt abdominal trauma] is [radiological imaging necessary] to [identify clinically significant renal injury]?
Search strategy
Medline 1966–10/01 using the OVID interface, Embase 1988–10/01. [exp haematuria OR haematuria.mp] AND microscopic.mp AND trauma$.mp
Search outcome
Altogether 55 publications identified, 15 of these have direct relevance to the three part question. A further two relevant papers were referenced in these. Of these 17 papers 10 were of sufficient quality for inclusion (see table 1).
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 after blunt abdominal trauma, in patients who were not shocked and had no major associated injuries. Of these one had a clinically significant renal injury.
CLINICAL BOTTOM LINE
Radiological imaging of the renal tract is not indicated in adults with microscopic haematuria after blunt abdominal trauma, provided they are not shocked and have no major associated injuries.
Report by Fiona Saunders,Specialist Registrar Search checked by Jon Argall, Senior Clinical Fellow