Levitt M A, Criss E, Kobernick M
Ann Emerg Med. 1985 Oct;14(10):959-65. doi: 10.1016/s0196-0644(85)80237-7.
A retrospective study was performed to determine if the emergency intravenous pyelogram (IVP) is being overused in the evaluation of blunt renal trauma. Medical records of 105 blunt renal trauma patients undergoing IVPs for suspected blunt renal trauma were analyzed. Eighty-eight patients (83.8%) had normal IVPs, and 17 patients (16.2%) had abnormal IVPs. Three of the 105 patients (2.9%) required urologic surgical intervention. The medical records of these patients were examined in detail because it was believed that this patient population needed to be identified by emergency IVP. All three patients requiring urologic surgery had gross hematuria. All three patients had one or more associated injuries. Two of the three patients had flank tenderness and/or flank mass. The third patient was obtunded. From this study and information from the literature an algorithm has been constructed as a guideline for a prospective study. Following this guideline no patients in the study requiring urologic surgical intervention would have been missed. Of patients requiring an emergency IVP, 7.3% would have required urologic surgery. This would have resulted in a savings of $10,432 at our institution.
进行了一项回顾性研究，以确定急诊静脉肾盂造影（IVP）在钝性肾外伤评估中是否被过度使用。分析了105例因疑似钝性肾外伤而接受IVP检查的钝性肾外伤患者的病历。88例患者（83.8%）IVP结果正常，17例患者（16.2%）IVP结果异常。105例患者中有3例（2.9%）需要泌尿外科手术干预。对这些患者的病历进行了详细检查，因为认为这部分患者需要通过急诊IVP来识别。所有3例需要泌尿外科手术的患者均有肉眼血尿。所有3例患者均有一处或多处合并伤。3例患者中有2例有胁腹压痛和/或胁腹肿块。第3例患者昏迷。根据这项研究以及文献中的信息，构建了一种算法作为前瞻性研究的指南。遵循该指南，本研究中需要泌尿外科手术干预的患者均不会被漏诊。在需要急诊IVP的患者中，7.3%的患者需要泌尿外科手术。这将为本机构节省10432美元。
