钝性创伤中镜下血尿和肉眼血尿作为膀胱损伤预测指标的前瞻性比较。

Prospective comparison of microscopic and gross hematuria as predictors of bladder injury in blunt trauma.

作者信息

Brewer M Eric, Wilmoth Robert J, Enderson Blaine L, Daley Brian J

机构信息

Department of Urology, University of Tennessee Medical Center at Knoxville, Knoxville, Tennessee 37920, USA.

出版信息

Urology. 2007 Jun;69(6):1086-9. doi: 10.1016/j.urology.2007.02.056.

DOI:10.1016/j.urology.2007.02.056

PMID:17572192

Abstract

OBJECTIVES

The evaluation of the genitourinary system in patients with blunt trauma remains controversial. Historically, patients with more than 50 red blood cells on urinalysis underwent additional genitourinary imaging. Retrospective studies have demonstrated that bladder injury is almost always associated with gross hematuria. We have prospectively demonstrated that bladder imaging is required for gross hematuria and unnecessary for microscopic hematuria.

METHODS

Patients sustaining blunt trauma with hematuria were prospectively evaluated during a 3-year period. During the first 18 months of the study (first treatment arm), patients with microscopic hematuria (more than 50 red blood cells on urinalysis) underwent bladder imaging. During the second 18 months, patients underwent bladder imaging only for gross hematuria.

RESULTS

A total of 8026 patients were evaluated. In the first arm, 214 patients underwent cystography for microscopic hematuria, and no bladder injuries were identified; 78 patients underwent cystography for gross hematuria, and 21 bladder injuries were identified. Chi-square analysis revealed no difference in the presence of microscopic hematuria to predict for bladder injury. In the second arm, 308 patients presented with microscopic hematuria, none of whom underwent cystography, and 91 patients underwent cystography for gross hematuria, with 15 bladder injuries identified. The presence of gross hematuria demonstrated 100% sensitivity and 98.5% specificity as a screening test for bladder injury. No bladder injuries were missed.

CONCLUSIONS

The results of our study have shown that the presence of gross hematuria warrants evaluation of the bladder. The presence of gross hematuria demonstrated improved sensitivity, specificity, positive predictive value, negative predictive value, and accuracy over the presence of microscopic hematuria in the detection of bladder injury. Using gross hematuria as an indication for bladder imaging will eliminate unnecessary imaging without compromising the quality of patient care.

摘要

目的

钝性创伤患者泌尿生殖系统的评估仍存在争议。从历史上看，尿液分析中红细胞超过50个的患者需接受额外的泌尿生殖系统影像学检查。回顾性研究表明，膀胱损伤几乎总是与肉眼血尿相关。我们前瞻性地证明，肉眼血尿需要进行膀胱影像学检查，而镜下血尿则无需此项检查。

方法

对3年内因钝性创伤伴血尿的患者进行前瞻性评估。在研究的前18个月（第一个治疗组），镜下血尿（尿液分析中红细胞超过50个）的患者接受膀胱影像学检查。在随后的18个月，患者仅在出现肉眼血尿时接受膀胱影像学检查。

结果

共评估了8026例患者。在第一个治疗组中，214例镜下血尿患者接受了膀胱造影，未发现膀胱损伤；78例肉眼血尿患者接受了膀胱造影，发现21例膀胱损伤。卡方分析显示，镜下血尿对预测膀胱损伤无差异。在第二个治疗组中，308例镜下血尿患者均未接受膀胱造影，91例肉眼血尿患者接受了膀胱造影，发现15例膀胱损伤。肉眼血尿作为膀胱损伤筛查试验的敏感性为100%，特异性为98.5%。未漏诊膀胱损伤。