97.07 Does Microscopic Hematuria After Blunt Abdominal Trauma in Children Indicate Clinically Significant Injury?

Posted on January 31, 2019

C. Casson1, A. Beres1,2  1University of Texas at Southwestern,Dallas, TX, USA 2Children’s Health,Dallas, TX, USA

Introduction:
Children are more likely than adults to have urinary system injury following blunt abdominal trauma (BAT) due to several anatomical vulnerabilities. Urinalysis is often performed during initial evaluation to screen for injury. The purpose of this study was to determine how often the finding of microscopic hematuria after BAT leads to further testing and whether this finding indicates a clinically significant injury. 

Methods:
A retrospective chart review of children who were evaluated for BAT at Children’s Health from 2013-2017 was performed. Patients included had microscopic hematuria leading to further workup. Data collected included demographics, mechanism and types of injuries, laboratory and imaging data, and outcomes. Data was analyzed using descriptive statistics, Chi-square, and Wilcoxin test.

Results:
248 patients had microscopic hematuria following BAT. Most patients had UA results after imaging was completed. 45 patients were found to have microscopic hematuria leading to additional workup: CT abdomen/pelvis (82%), renal ultrasound (13%), XR/CT cystogram (29%), repeat urinalysis (76%). Of these 45 patients, the majority (82%) had a urinalysis performed as a part of an initial trauma workup without any symptoms of urinary system injury. Eight patients had a negative CT scan prior to finding hematuria, but still went on to have XR/CT cystograms. 17 patients were scanned solely due to the finding of microscopic hematuria on screening urinalysis. 9 patients were found to have a urinary system injury: 6 low grade renal and 3 patients with bladder wall. 2/8 patients with urology consults required any outpatient follow-up and no patients were taken to the OR.

Conclusion:
Microscopic hematuria on screening urinalysis after BAT leads to extensive workup, regardless of the presence of symptoms. Urinary system injury presenting solely with microscopic hematuria is uncommon, with all injuries in this study being clinically non-significant.