Taylor G A, Eichelberger M R, Potter B M
Department of Radiology, Children's Hospital National Medical Center, Washington, D.C. 20010.
Ann Surg. 1988 Dec;208(6):688-93. doi: 10.1097/00000658-198812000-00003.
The clinical significance of hematuria after blunt trauma was studied in 378 consecutive children evaluated by computed tomography (CT) of the abdomen. Clinical and demographic data, as well as indications for CT (such as hematuria, abdominal tenderness, distention, contusions, and abrasions) were recorded prospectively at the time of CT examination. Hematuria was present in 256 children (68%). Of these, 168 (66%) had microscopic blood (greater than or equal to 10 RBC/HPF), 52 (20%) had a positive dip-stick (less than 10 RBC/HPF), and 36 (14%) had gross hematuria. Both the presence and increasing amount of blood in the urine were associated with significantly higher risk for abdominal injury, multiple organ trauma, and renal injury. Yet when asymptomatic hematuria was the only indication for CT examination, the risk of any abdominal injury was negligible (0 of 41 patients). The presence and severity of hematuria can be useful markers of underlying abdominal injury only in association with other suggestive clinical signs and symptoms. Asymptomatic hematuria is a low-yield indication for abdominal CT in children with blunt abdominal trauma.
对378例接受腹部计算机断层扫描（CT）评估的连续儿童钝性创伤后血尿的临床意义进行了研究。在CT检查时前瞻性记录临床和人口统计学数据，以及CT检查的指征（如血尿、腹部压痛、腹胀、挫伤和擦伤）。256例儿童（68%）存在血尿。其中，168例（66%）有镜下血尿（≥10个红细胞/高倍视野），52例（20%）尿试纸检测阳性（<10个红细胞/高倍视野），36例（14%）有肉眼血尿。尿中血液的存在及其量的增加与腹部损伤、多器官创伤和肾损伤的风险显著升高相关。然而，当无症状血尿是CT检查的唯一指征时，任何腹部损伤的风险可忽略不计（41例患者中0例）。血尿的存在和严重程度仅与其他提示性临床体征和症状相关时，才可能是潜在腹部损伤的有用标志物。无症状血尿对于钝性腹部创伤儿童的腹部CT检查来说是一个低收益指征。
