Routine CT, using excreted contrast only, cannot be relied on entirely to diagnose bladder rupture, even with a urethral catheter inserted and clamped [35-37]. CT performed with excreted contrast only can demonstrate intraperitoneal or extraperitoneal fluid, but it cannot differentiate urine from ascites. However, the absence of pelvic ascites is strong evidence against an intraperitoneal bladder rupture [38,39]. As with IV urography (IVU), the bladder is usually inadequately distended to cause extravasation through a bladder laceration or perforation during routine abdominal and pelvic studies. A negative study does not exclude bladder injury [40]. Although CT is not the technique of choice for urethral injuries, it is performed so frequently that urethral injuries are often identified when CT is performed for pelvic trauma. CT Whole Body No practice consensus or validated decision rules currently exist for deciding which patients should receive WBCT versus selective CT imaging of the abdomen and pelvis for blunt trauma. Some studies have found a survival benefit to WBCT compared with selective CT [14], whereas others have found no mortality benefit [15]. Meta-analyses have found conflicting results with respect to improvements in mortality [16-18]. Therefore, clinical judgement remains vital for determining which patients should obtain selective CT versus WBCT. Indications that may warrant WBCT imaging as defined above include high-velocity (>35 mph) MVC, MVC resulting in rollover or passenger ejection, motorcycle trauma, bicycle injury, MVC-pedestrian collision, and a fall from a height of >15 feet. Additional considerations include patient age and functional status, hemodynamic stability, neurological status, and results of initial imaging from portable radiographs of the chest and pelvis, and/or FAST.
Major Blunt Trauma. Routine CT, using excreted contrast only, cannot be relied on entirely to diagnose bladder rupture, even with a urethral catheter inserted and clamped [35-37]. CT performed with excreted contrast only can demonstrate intraperitoneal or extraperitoneal fluid, but it cannot differentiate urine from ascites. However, the absence of pelvic ascites is strong evidence against an intraperitoneal bladder rupture [38,39]. As with IV urography (IVU), the bladder is usually inadequately distended to cause extravasation through a bladder laceration or perforation during routine abdominal and pelvic studies. A negative study does not exclude bladder injury [40]. Although CT is not the technique of choice for urethral injuries, it is performed so frequently that urethral injuries are often identified when CT is performed for pelvic trauma. CT Whole Body No practice consensus or validated decision rules currently exist for deciding which patients should receive WBCT versus selective CT imaging of the abdomen and pelvis for blunt trauma. Some studies have found a survival benefit to WBCT compared with selective CT [14], whereas others have found no mortality benefit [15]. Meta-analyses have found conflicting results with respect to improvements in mortality [16-18]. Therefore, clinical judgement remains vital for determining which patients should obtain selective CT versus WBCT. Indications that may warrant WBCT imaging as defined above include high-velocity (>35 mph) MVC, MVC resulting in rollover or passenger ejection, motorcycle trauma, bicycle injury, MVC-pedestrian collision, and a fall from a height of >15 feet. Additional considerations include patient age and functional status, hemodynamic stability, neurological status, and results of initial imaging from portable radiographs of the chest and pelvis, and/or FAST.