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Urinalysis in Adult Blunt Trauma Patients, Is It Relevant Today?
232 ferentiated emergency department (ED) patients are lacking. The objective of this study was to determine the sensitivity of ESR and CRP in the diagnosis of SA. Methods: Retrospective analysis of ED patients diagnosed with of SA between January 2003 and December 2008. Eligible patients had an ICD-9 (International Classification of Diseases, 9th Revision) diagnosis of pyogenic arthritis (711.0x) and one of the following: 1) positive synovial fluid culture; 2) positive synovial Gram stain for bacteria; or 3) operative irrigation for SA. Patients were excluded if no ESR or CRP were performed within 24 h of ED visit. Descriptive statistics and univariate analysis were performed. Sensitivity was calculated with 95% confidence interval (CI). The Partners Healthcare Human Research Committee approved the study. Results: We identified 143 patients with SA. The mean age was 49 (⫾ 22) years, and 85 (59%) were male. Race was: 125 (87%) white, 4 (3%) black, and 12 (8%) Hispanic. Thirty-five (24%) had infection of prosthetic joints. Synovial cultures were positive in 102 (71%). ESR was done in 140 (98%), CRP in 96 (67%), and both tests in 93 (65%) patients. Sensitivity of ESR was: 97% (95% CI 92– 99%) using a cutoff of ⬎ 10 mm/h, 86% (95% CI 79 –91%) using ⬎ 20 mm/h, and 78% (95% CI 70 – 84%) using ⬎ 30 mm/h. Sensitivity of CRP was 92% (95% CI 84 –96%) using a cutoff of ⬎ 20 mg/L, 80% (95% CI 71– 87%) using ⬎ 40 mg/L, and 73% (95% CI 63– 81%) using ⬎ 60 mg/L. Using a combination of ESR and CRP, the sensitivity was: 99% (95% CI 94 –100%) using ESR ⬎ 10 mm/h or CRP ⬎ 20 mg/L; 96% (95% CI 90 –98%) using ESR ⬎ 20 mm/h or CRP ⬎ 40 mg/L; and 89% (95% CI 82–93%) using ESR ⬎ 30 mm/h or CRP ⬎ 60 mg/L. Conclusion: ESR and CRP are sensitive tests for SA, but only when very low cutoffs are used. At such low cutoffs, these tests are unlikely to have sufficient specificity to be clinically useful.
e URINALYSIS IN ADULT BLUNT TRAUMA PATIENTS, IS IT RELEVANT TODAY? J.A. Gorchynski, JPS Health Network, University of Texas Southwest, Fort Worth, TX; A. DeLeon, CHRISTUS Spohn Health System, Texas A&M, Corpus Christi, TX. Objective: To evaluate the utility of the initial emergency department (ED) urinalysis (UA) in adult blunt trauma patients as a screening tool for the detection of intra- abdominal injuries (IAIs), specifically liver, spleen, or hollow viscus. Methods: Prospective study of consecutive adult blunt trauma patients that presented to a tertiary care teaching hospital, Level II trauma center who received an abdominal or whole body (panscan) computed tomography (CT) scan or an exploratory laparotomy (ex-lap) and an initial UA. Subjects were excluded if a UA was not obtained or if an abdominal CT scan, panscan CT, or an ex-lap was not performed. The presence of urobilinogen, urine hemoglobin, urine bilirubin, and red blood cells in the UA were reported. CT scans and operative reports were reviewed for evidence of liver, spleen, small bowel, or mesenteric injuries. Results: The sample population included 159 subjects, with 6 subjects excluded due to the absence of an ED UA. Of the 153 study subjects, the mean age was 43 years, with 94 males, 58 trauma activations (38%), and 102 (67%) motor vehicle accidents. There were 95 (62%) abnormal UAs, with 48 (31%) IAIs in 40 (26%) subjects. Test characteristics for the
The Journal of Emergency Medicine presence of an IAI stratified by abnormal UA were as follows: urobilinogen prevalence 55%, SN 0.55 (95% confidence interval [CI] 0.39 – 0.70), SP 0.68 (95% CI 0.59 – 0.76), odds ratio (OR) 2.38; UA hemoglobin prevalence 2.5%, SN 0.18 (95% CI 0.08 – 0.33), SP 0.85 (95% CI 0.77– 0.91),OR 0.72; UA bilirubin prevalence 17.5%, SN 0.03 (95% CI 0 – 0.15), SP 0.94 (95% CI 0.87– 0.97), OR 1.12; hematuria prevalence 26%, SN 0.53 (95% CI 0.36 – 0.68), SP 0.71 (95% CI 0.61– 0.79), OR 2.68. Conclusion: This is the first prospective study to investigate the utility of an abnormal ED UA for the detection of IAI adult blunt trauma patients. Our data demonstrate that the routine initial ED UA is not clinically useful as a screening tool for the detection of an IAI where CT panscan is routine. However, an abnormal UA may be utilized as an adjunct tool in addition to the physicians’ clinical assessment for further investigation for IAIs where CT imaging is limited or not readily available in countries outside of the US. e RISE IN EMERGENCY DEPARTMENT VISITS OF PEDIATRIC PATIENTS FOR RENAL COLIC FROM 1999 TO 2008. N. Kairam, J.R. Allegra, Morristown Memorial Hospital, Morristown, NJ; B. Eskin, Emergency Medical Associates Research Foundation, Livingston, NJ. Objective: Renal colic is predominantly a disease of adults with only occasional cases occurring in the pediatric population. A recent report from a single hospital showed a rise in the number of children with renal colic. Our objective was to confirm this in a large multi-hospital database of emergency department (ED) visits. Methods: Design: Retrospective cohort. Setting: Consecutive pediatric patients (aged ⬍ 18 years) with the ICD-9 (International Classification of Diseases, 9th Revision) diagnosis of “renal colic, calculus kidney, calculus ureter, urinary calculus, or uretheral calculus” seen by ED physicians in 29 urban, suburban, and rural EDs in New Jersey and New York between January 1, 1999 and December 31, 2008. We analyzed the number of renal colic visits as a percent of total ED pediatric visits in yearly intervals using the Student’s t-test and performed a regression analysis. Alpha was set at 0.05. Results: The database contained 6,497,458 total ED visits, of which 1,312,487 (20%) were pediatric visits. Of these, 1028 (0.078%) were for renal colic. The median age was 16 years (interquartile range: 13 years–17 years) and 61% were female. The percentage of ED pediatric visits for renal colic increased from 0.050% in 1999 to 0.089% in 2008, an increase of 78% (95% confidence interval 31–224%, p ⬍ 0.003). The correlation coefficient for this upward trend was R squared ⫽ 0.63 (p ⬍ 0.007). Conclusion: We found a marked increase in ED pediatric visits for renal colic over the past decade. This may reflect a real increase in the incidence of renal colic in the pediatric population or an increased use of imaging modalities for abdominal and flank pain. e THE INCIDENCE OF CONTRAST-INDUCED NEPHROPATHY IN PATIENTS WITH NORMAL RENAL FUNCTION RECEIVING AN ABDOMINAL CT SCAN. A.C. Quinn, M. Dashevsky, A. Subramanian, R. Sinert, Department of Emergency Medicine, State University of New York-Downstate, Brooklyn, NY.
e URINALYSIS IN ADULT BLUNT TRAUMA PATIENTS, IS IT RELEVANT TODAY? J.A. Gorchynski, JPS Health Network, University of Texas Southwest, Fort Worth, TX; A. DeLeon, CHRISTUS Spohn Health System, Texas A&M, Corpus Christi, TX. Objective: To evaluate the utility of the initial emergency department (ED) urinalysis (UA) in adult blunt trauma patients as a screening tool for the detection of intra- abdominal injuries (IAIs), specifically liver, spleen, or hollow viscus. Methods: Prospective study of consecutive adult blunt trauma patients that presented to a tertiary care teaching hospital, Level II trauma center who received an abdominal or whole body (panscan) computed tomography (CT) scan or an exploratory laparotomy (ex-lap) and an initial UA. Subjects were excluded if a UA was not obtained or if an abdominal CT scan, panscan CT, or an ex-lap was not performed. The presence of urobilinogen, urine hemoglobin, urine bilirubin, and red blood cells in the UA were reported. CT scans and operative reports were reviewed for evidence of liver, spleen, small bowel, or mesenteric injuries. Results: The sample population included 159 subjects, with 6 subjects excluded due to the absence of an ED UA. Of the 153 study subjects, the mean age was 43 years, with 94 males, 58 trauma activations (38%), and 102 (67%) motor vehicle accidents. There were 95 (62%) abnormal UAs, with 48 (31%) IAIs in 40 (26%) subjects. Test characteristics for the
The Journal of Emergency Medicine presence of an IAI stratified by abnormal UA were as follows: urobilinogen prevalence 55%, SN 0.55 (95% confidence interval [CI] 0.39 – 0.70), SP 0.68 (95% CI 0.59 – 0.76), odds ratio (OR) 2.38; UA hemoglobin prevalence 2.5%, SN 0.18 (95% CI 0.08 – 0.33), SP 0.85 (95% CI 0.77– 0.91),OR 0.72; UA bilirubin prevalence 17.5%, SN 0.03 (95% CI 0 – 0.15), SP 0.94 (95% CI 0.87– 0.97), OR 1.12; hematuria prevalence 26%, SN 0.53 (95% CI 0.36 – 0.68), SP 0.71 (95% CI 0.61– 0.79), OR 2.68. Conclusion: This is the first prospective study to investigate the utility of an abnormal ED UA for the detection of IAI adult blunt trauma patients. Our data demonstrate that the routine initial ED UA is not clinically useful as a screening tool for the detection of an IAI where CT panscan is routine. However, an abnormal UA may be utilized as an adjunct tool in addition to the physicians’ clinical assessment for further investigation for IAIs where CT imaging is limited or not readily available in countries outside of the US. e RISE IN EMERGENCY DEPARTMENT VISITS OF PEDIATRIC PATIENTS FOR RENAL COLIC FROM 1999 TO 2008. N. Kairam, J.R. Allegra, Morristown Memorial Hospital, Morristown, NJ; B. Eskin, Emergency Medical Associates Research Foundation, Livingston, NJ. Objective: Renal colic is predominantly a disease of adults with only occasional cases occurring in the pediatric population. A recent report from a single hospital showed a rise in the number of children with renal colic. Our objective was to confirm this in a large multi-hospital database of emergency department (ED) visits. Methods: Design: Retrospective cohort. Setting: Consecutive pediatric patients (aged ⬍ 18 years) with the ICD-9 (International Classification of Diseases, 9th Revision) diagnosis of “renal colic, calculus kidney, calculus ureter, urinary calculus, or uretheral calculus” seen by ED physicians in 29 urban, suburban, and rural EDs in New Jersey and New York between January 1, 1999 and December 31, 2008. We analyzed the number of renal colic visits as a percent of total ED pediatric visits in yearly intervals using the Student’s t-test and performed a regression analysis. Alpha was set at 0.05. Results: The database contained 6,497,458 total ED visits, of which 1,312,487 (20%) were pediatric visits. Of these, 1028 (0.078%) were for renal colic. The median age was 16 years (interquartile range: 13 years–17 years) and 61% were female. The percentage of ED pediatric visits for renal colic increased from 0.050% in 1999 to 0.089% in 2008, an increase of 78% (95% confidence interval 31–224%, p ⬍ 0.003). The correlation coefficient for this upward trend was R squared ⫽ 0.63 (p ⬍ 0.007). Conclusion: We found a marked increase in ED pediatric visits for renal colic over the past decade. This may reflect a real increase in the incidence of renal colic in the pediatric population or an increased use of imaging modalities for abdominal and flank pain. e THE INCIDENCE OF CONTRAST-INDUCED NEPHROPATHY IN PATIENTS WITH NORMAL RENAL FUNCTION RECEIVING AN ABDOMINAL CT SCAN. A.C. Quinn, M. Dashevsky, A. Subramanian, R. Sinert, Department of Emergency Medicine, State University of New York-Downstate, Brooklyn, NY.