PEDIATRICS Vol. 82 No. 2 August 1988, pp. 216-222
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Hematuria and Clinical Findings as Indications for Intravenous Pyelography in Pediatric Blunt Renal Trauma

Tracy A. Lieu MD1, Gary R. Fleisher MD1, Soroosh Mahboubi MD1, and J. Sanford Schwartz MD1

1 From the Dana Scholars Program; Section of Emergency Pediatrics, Department of Pediatrics; Department of Radiology; and Section of General Medicine, Department of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania School of Medicine, Philadelphia

The essential aids in the evaluation of suspected blunt urinary tract injury are urinalysis and IVP. In 78 consecutive children who had IVPs because of trauma from January 1982 to March 1986, the following were evaluated (1) the yield of IVP; (2) the correlations between IVP and hematuria, mechanism of injury, and associated clinical findings; and (3) the effect of IVP on patient management. Of the 26 children (33%) with abnormal IVP findings, 13 had congenital urinary tract anomalies only and 13 had urinary tract injuries (eight renal contusions, four renal lacerations with extravasation, and one bladder rupture). The number of RBCs per high-power field correlated with IVP evidence of injury (P < .05). If only those patients with ge20 RBCs per high-power field had received IVPs, 42% of IVPs would have been avoided and no injuries or surgically correctable anomalies would have been overlooked. Urinary tract injury occurred significantly more often in patients with extremity fractures (P < .05) and pelvic fractures (P < .05). Mechanism of injury, admission to the hospital, and flank tenderness or hematoma were not associated with IVP evidence of trauma (P > .05), however. In four patients with trauma, results of IVP led to lengthened hospitalization or further diagnostic studies but did not result in surgery. Two patients in whom ureteropelvic junction obstruction was discovered incidentally had delayed corrective surgery. It is concluded that (1) IVP has a substantially higher yield among children with ge20 RBCs per high-power field; (2) for those with <20 RBCs per high-power field, IVP still may be required based on clinical findings; and (3) abnormal IVP findings influence the management of children with trauma in a minority of cases.

Key Words: trauma • urinary tract • kidney • radiology • hematuria • intravenous pyelography

Submitted on October 12, 1987
Accepted on October 28, 1987