Investigating microscopic haematuria in blunt abdominal trauma

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. Clinical scenarioA 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 outcomeAltogether 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.c 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. Best evidence topic reports (BETs) summarise the evidence pertaining to particular clinical questions. They are not systematic reviews, but rather contain the best (highest level) evidence that can be practically obtained by busy practising clinicians. The search strategies used to find the best evidence are reported in detail in order to allow clinicians to update searches whenever necessary. The BETs published below were first reported at the Critical Appraisal Journal Club at the Manchester Royal Infirmary 1 or placed on the BestBETs web site. Each BET has been constructed in the four stages that have been described elsewhere.2 The BETs shown here together with those published previously and those currently under construction can be seen at the bestbets web site (http:// www.bestbets.org).3 Ten BETs are included in this issue of the journal.