346 ULTRASOUND DETECTION OF BLUNT UROLOGICAL TRAUMA: A SIX YEAR STUDY

The objective of this study was to assess the utility of emergency ultrasonography in the detection of blunt urological injuryA retrospective review was conducted of all consecutive emergency blunt trauma ultrasonograms (US) obtained at a level I trauma center from January 1995 to January 2001. 4320 emergency ultrasonograms were performed, and 596 patients (14%) had intraabdominal injury. The sensitivity of ultrasound for isolated urological injuries was 55.6%, and specificity was 99.8%. Ultrasound was most accurate in the detection of grade III urological injuries, identifying 14 of 15, with 13 injuries requiring laparotomy. For isolated urological injuries, 15 of 25 patients with a true positive US required laparotomy compared to 3 of 20 with a false negative US. Isolated urological injury was significantly associated with an ultrasonographic pattern of free fluid in the left upper quadrant and left pericolic gutter (odds ratio = 55.1; P ≤0.001), followed by isolated fluid in the left pericolic gutter (odds ratio= 8.6; P = 0.04). Although emergency ultrasonography is useful in the triage of patients with blunt urological trauma, it may miss significant urological injury requiring further intervention. Based on clinical findings, further studies such as contrast-enhanced CT or exploratory laparatomy should be performed. (Table)Table 1Ultrasonographic Detection of Free Fluid and Parenchymal Injuries