Moustafa F, Loze C, Pereira B, Vaz M A, Caumon L, Perrier C, Schmidt J
Service des urgences, Pôle SAMU-SMUR-Urgences, CHU Gabriel Montpied, Clermont-Ferrand, France.
Direction de la Recherche Clinique et de l'Innovation, Département de Biostatistiques, CHU Gabriel Montpied, Clermont-Ferrand, France.
Am J Emerg Med. 2017 Apr;35(4):628-631. doi: 10.1016/j.ajem.2016.12.047. Epub 2016 Dec 22.
Clinicians still face significant challenge in predicting intra-abdominal injuries in patients admitted to an emergency department for blunt abdominal trauma. This study was thus designed to investigate the value of dipstick urinalysis in patients with blunt abdominal trauma.
We performed a retrospective, multicenter, cohort study involving patients admitted to the emergency department for abdominal traumas, examined by means of urinary dipstick and abdominal CT scan. The primary endpoint was the correlation between microscopic hematuria detected via dipstick urinalysis (defined by the presence of blood on the dipstick urinalysis but without gross hematuria) and abdominal injury, as evidenced on CT scan.
Of the 100 included patients, 56 experienced microscopic hematuria, 17 gross hematuria, and 44 no hematuria. Patients with abdominal injury were more likely to present with hypovolemic shock (odds ratio [OR]: 8.4; 95% confidence interval [CI]: 2.7-26), abdominal wall hematoma (OR: 3.1; 95% CI: 1.2-7.9), abdominal defense (OR: 5.2; 95% CI: 1.8-14.5), or anemia (OR: 3.6; 95% CI: 1.2-10.3). Moreover, dipstick urinalysis was less likely to predict injury, with just 72.2% sensitivity (95% CI: 54.8-85.8), 53.1% specificity (95% CI: 40.2-65.7), and positive and negative predictive values of 46.4% (95% CI: 33.0-60.3) and 77.3% (95% CI: 62.2-88.5), respectively.
Dipstick urinalysis was neither adequately specific nor sensitive for predicting abdominal injury and should thus not be used as a key assessment component in patients suffering from blunt abdominal trauma, with physical exam and vital sign assessment the preferred choice.
对于因钝性腹部创伤而入住急诊科的患者，临床医生在预测腹腔内损伤方面仍面临重大挑战。因此，本研究旨在探讨试纸法尿液分析在钝性腹部创伤患者中的价值。
我们进行了一项回顾性、多中心队列研究，纳入因腹部创伤入住急诊科的患者，通过试纸法尿液分析和腹部CT扫描进行检查。主要终点是通过试纸法尿液分析检测到的镜下血尿（定义为试纸法尿液分析显示有血液但无肉眼血尿）与CT扫描显示的腹部损伤之间的相关性。
在纳入的100例患者中，56例出现镜下血尿，17例出现肉眼血尿，44例无血尿。腹部损伤患者更有可能出现低血容量性休克（比值比[OR]：8.4；95%置信区间[CI]：2.7 - 26）、腹壁血肿（OR：3.1；95% CI：1.2 - 7.9）、腹部防御反应（OR：5.2；95% CI：1.8 - 14.5）或贫血（OR：3.6；95% CI：1.2 - 10.3）。此外，试纸法尿液分析预测损伤的可能性较小，敏感性仅为72.2%（95% CI：54.8 - 85.8），特异性为53.1%（95% CI：40.2 - 65.7），阳性预测值和阴性预测值分别为46.4%（95% CI：33.0 - 60.3）和77.3%（95% CI：62.2 - 88.5）。
试纸法尿液分析在预测腹部损伤方面既没有足够的特异性也没有足够的敏感性，因此不应用作钝性腹部创伤患者的关键评估指标，体格检查和生命体征评估仍是首选。
