Although US may be able to diagnose certain thoracic and abdominal injuries, its relatively lower sensitivity compared with CT does not make it a sufficient test to exclude injuries to these areas, particularly extraperitoneal or genitourinary injuries [5,41,42]. In a series of 128 acute trauma patients, 11 of 19 injuries that were missed by emergent US involved the genitourinary system [41]. The detection of peritoneal fluid in the presence of normal viscera or the failure to visualize the bladder after the transurethral introduction of saline is considered highly suggestive of bladder rupture [35]. As a practical matter, US is not definitive in bladder or urethral trauma and is almost never used for this indication. Radiography Intravenous Urography There is no relevant literature to support the use of IVU in patients who are hemodynamically stable with suspected urinary system or urethral trauma. IVU has a low accuracy, on the order of 15% to 25% [43]. In one study, an Major Blunt Trauma accurate diagnosis of bladder rupture was made with IVU in only 5 of 23 (22%) patients [44]. Carroll and McAninch [45] found an accurate diagnosis for only 5 of 32 (16%) patients, and Werkman et al [46] found an accuracy rate for only 4 of 11 (36%) patients. Fluoroscopy Retrograde Urethrography In a male, gross blood at the urethral meatus may indicate a urethral injury, which warrants further evaluation with a retrograde urethrogram to evaluate urethral integrity [47]. Radiography Trauma Series Trauma series radiographs typically consist of portable radiographs of the chest and pelvis. A portable radiograph of the pelvis can evaluate for unstable pelvic injuries and hip dislocation [4]. A pelvic injury is associated with genitourinary trauma. A portable AP chest radiograph helps screen for immediately life-threatening findings, such as tension pneumothorax and significant mediastinal injury, as well as confirms line placement [13]. Variant 7: Major blunt trauma. Hemodynamically stable.
Major Blunt Trauma. Although US may be able to diagnose certain thoracic and abdominal injuries, its relatively lower sensitivity compared with CT does not make it a sufficient test to exclude injuries to these areas, particularly extraperitoneal or genitourinary injuries [5,41,42]. In a series of 128 acute trauma patients, 11 of 19 injuries that were missed by emergent US involved the genitourinary system [41]. The detection of peritoneal fluid in the presence of normal viscera or the failure to visualize the bladder after the transurethral introduction of saline is considered highly suggestive of bladder rupture [35]. As a practical matter, US is not definitive in bladder or urethral trauma and is almost never used for this indication. Radiography Intravenous Urography There is no relevant literature to support the use of IVU in patients who are hemodynamically stable with suspected urinary system or urethral trauma. IVU has a low accuracy, on the order of 15% to 25% [43]. In one study, an Major Blunt Trauma accurate diagnosis of bladder rupture was made with IVU in only 5 of 23 (22%) patients [44]. Carroll and McAninch [45] found an accurate diagnosis for only 5 of 32 (16%) patients, and Werkman et al [46] found an accuracy rate for only 4 of 11 (36%) patients. Fluoroscopy Retrograde Urethrography In a male, gross blood at the urethral meatus may indicate a urethral injury, which warrants further evaluation with a retrograde urethrogram to evaluate urethral integrity [47]. Radiography Trauma Series Trauma series radiographs typically consist of portable radiographs of the chest and pelvis. A portable radiograph of the pelvis can evaluate for unstable pelvic injuries and hip dislocation [4]. A pelvic injury is associated with genitourinary trauma. A portable AP chest radiograph helps screen for immediately life-threatening findings, such as tension pneumothorax and significant mediastinal injury, as well as confirms line placement [13]. Variant 7: Major blunt trauma. Hemodynamically stable.