Emergency intravenous pyelography in the trauma patient. A reexamination of the indications
J. B. Fortune, J. Brahme, M. Mulligan and T. L. Wachtel
Because of the high incidence of abnormal intravenous pyelograms (IVPs) in
victims of blunt trauma undergoing resuscitation, a retrospective review of
the Trauma Registry at the University of California, San Diego Medical
Center, was undertaken to evaluate the indications for ordering this test.
The charts of 216 patients were reviewed, all of whom had formal IVPs (four
films) done as an emergency procedure at the time of admission. In this
study, special attention was directed toward comparing both the degree of
hematuria and the anatomic site of injury with the results of the IVP. A
total of 20 renal injuries was detected by IVP. Of these injuries, all but
one had hematuria that was greater than 50 red blood cells per high-power
field. All but one of the abnormal IVPs were associated with obvious
abdominal injuries. The results of the IVP influenced the clinical course
of only one patient in the entire series. We conclude that the use of the
formal IVP (four films) in the resuscitation phase of treating the multiply
traumatized patient be reserved for those patients with penetrating
abdominal injury or with hematuria consisting of greater than 50 red blood
cells per high-power field. For any major blunt abdominal trauma without
significant hematuria, a more simple and rapid study (one-shot IVP) to
demonstrate bilateral nephrograms is probably adequate to rule out occult
renal artery thrombosis.
