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Use of intravenous pyelography in blunt trauma — A reappraisal
ABSTRACTS
the elevation of creatinine phosphokinase associated with intramuscular injections. Joanne M Edney, MD
intravenous pyelography, blunt trauma
U s e of i n t r a v e n o u s p y e l o g r a p h y in b l u n t trauma m A reappraisal Hoffman JR, Simon RR, Smith M, et al West J Med 146:576-579 May 1987
In a retrospective cohort study charts of 150 consecutive patients receiving intravenous pyelogram (IVP) following blunt trauma were reviewed. Attention was directed to any clinical or laboratory findings correlating with an abnormal IVP and whether the results of the IVP affected management of the patient. Of clinical findings commonly used as indications for IVP in the setting of blunt trauma, ie, back pain, groin pain, abdominal tenderness, CVA tenderness, transverse process fracture, lower rib fracture, and gross hematuria, only gross hematuria was statistically significant in its association with an abnormal IVP. The sensitivity, specificity, and positive and negative predictive values were 44%, 87%, 17%, and 96%, respectively. Conversely, 42 of 43 patients (98%) with < 10 RBC/hpf had a n o r m a l IVP, suggesting t h a t absence of m i c r o s c o p i c hematuria has an excellent negative predictive value for genitourinary injury, Of the nine patients with abnormal IVPs, none had their management influenced by the test. The authors cite four other studies, all supporting the fact that the IVP rarely influences management. Indications for an IVP in blunt trauma are > 10 RBC/hpf in association with back pain, groin pain, transverse process fractures, or a highly suggestive mechanism of injury. Furthermore, it is again emphasized that an IVP is important for a patient undergoing exploratory laparotomy following trauma to demonstrate two functioning kidneys./Editor's note: It m u s t be emphasized that all the patients Jn this study had experienced blunt trauma. An IVP m a y be indicated even in the absence of hematuria when a penetrating injury has occurred in juxtaposition to the kidney] Paul Howes, MD
human immunodeficiency virus
Unsuspected human immunodeficiency v i r u s in c r i t i c a l l y ill e m e r g e n c y p a t i e n t s Baker JL, Kelen GD, Sivertson KT, et al JAMA 257:2609-2611
May 1987
203 critically ill or severely injured patients was performed in an urban emergency department investigating the frequency of HIV antibody seropositivity to determine the potential of unsuspected exposure to ED personnel and to determine if a "high risk" patient group could be identified. Six (3%) of the total were HIV antibody positive. All were between 25 and 34 years old and were victims of trauma. Five of these six were v i c t i m s of penetrating t r a u m a (gunshot or stab wounds), and they represented 19% of the 27 such patients in that age group; none were previously suspected as HIV infected. The 3% prevalence rate in this study is contrasted to the 0.8% prevalence rate in the general US population. A history of IV drug abuse did not prove to be a discriminator in this study. The authors suggest caution in extrapolating conclusions from these data because of the limited sample and because of the specific nature of their urban population. Mark W Elliott, MD
stroke, behavioral disturbance
I n o b v i o u s s t r o k e : A c a u s e of d e l i r i u m a n d dementia Dunne JW, Ledman PJ, Edis RH Aust NZ J Med 16:771-778
Jul 1986
A retrospective analysis of 661 patients with stroke proven by CT scan or autopsy was conducted to evaluate the frequency of disease presentation without specific localizing neurologic signs. Nineteen patients (four with cerebral hemorrhage and 15 with cerebral infarction) had behavioral abnormalities as their primary presenting feature with minimal, transient, or even absent neurologic findings. Nine patients demonstrated reversible acute delirium or organic personality disorders. Eight of the nine had a nondominant hemispheric lesion, and all demonstrated marked mood alterations, including paranoia, mania, emotional lability, and apathetic affect. Acute, irreversible dementia occurred in seven patients with predominantly right temporal and parietal lesions. This group had global impairment of cognitive ability involving memory, judgment, and abstract thought. Emotional lability, aggressiveness, and paranoia were typical of these patients. A final group of three patients developed delayed, intermittent behavioral abnormalities with hallucinations, delusions, and mania. All three developed EEG disturbances, two exhibiting epilepsy. The authors found the lesions involved in these 19 stroke patients usually located in the peri-Sylvian cortex of the nondominant hemisphere, accounting for the predominant emotional disorientation and paucity of limb neurologic abnormalities.
A prospective anonymous analysis of serum samples of
236/1094
Annals of Emergency Medicine
Michael Hunt, MD 16:9 September 1987
the elevation of creatinine phosphokinase associated with intramuscular injections. Joanne M Edney, MD
intravenous pyelography, blunt trauma
U s e of i n t r a v e n o u s p y e l o g r a p h y in b l u n t trauma m A reappraisal Hoffman JR, Simon RR, Smith M, et al West J Med 146:576-579 May 1987
In a retrospective cohort study charts of 150 consecutive patients receiving intravenous pyelogram (IVP) following blunt trauma were reviewed. Attention was directed to any clinical or laboratory findings correlating with an abnormal IVP and whether the results of the IVP affected management of the patient. Of clinical findings commonly used as indications for IVP in the setting of blunt trauma, ie, back pain, groin pain, abdominal tenderness, CVA tenderness, transverse process fracture, lower rib fracture, and gross hematuria, only gross hematuria was statistically significant in its association with an abnormal IVP. The sensitivity, specificity, and positive and negative predictive values were 44%, 87%, 17%, and 96%, respectively. Conversely, 42 of 43 patients (98%) with < 10 RBC/hpf had a n o r m a l IVP, suggesting t h a t absence of m i c r o s c o p i c hematuria has an excellent negative predictive value for genitourinary injury, Of the nine patients with abnormal IVPs, none had their management influenced by the test. The authors cite four other studies, all supporting the fact that the IVP rarely influences management. Indications for an IVP in blunt trauma are > 10 RBC/hpf in association with back pain, groin pain, transverse process fractures, or a highly suggestive mechanism of injury. Furthermore, it is again emphasized that an IVP is important for a patient undergoing exploratory laparotomy following trauma to demonstrate two functioning kidneys./Editor's note: It m u s t be emphasized that all the patients Jn this study had experienced blunt trauma. An IVP m a y be indicated even in the absence of hematuria when a penetrating injury has occurred in juxtaposition to the kidney] Paul Howes, MD
human immunodeficiency virus
Unsuspected human immunodeficiency v i r u s in c r i t i c a l l y ill e m e r g e n c y p a t i e n t s Baker JL, Kelen GD, Sivertson KT, et al JAMA 257:2609-2611
May 1987
203 critically ill or severely injured patients was performed in an urban emergency department investigating the frequency of HIV antibody seropositivity to determine the potential of unsuspected exposure to ED personnel and to determine if a "high risk" patient group could be identified. Six (3%) of the total were HIV antibody positive. All were between 25 and 34 years old and were victims of trauma. Five of these six were v i c t i m s of penetrating t r a u m a (gunshot or stab wounds), and they represented 19% of the 27 such patients in that age group; none were previously suspected as HIV infected. The 3% prevalence rate in this study is contrasted to the 0.8% prevalence rate in the general US population. A history of IV drug abuse did not prove to be a discriminator in this study. The authors suggest caution in extrapolating conclusions from these data because of the limited sample and because of the specific nature of their urban population. Mark W Elliott, MD
stroke, behavioral disturbance
I n o b v i o u s s t r o k e : A c a u s e of d e l i r i u m a n d dementia Dunne JW, Ledman PJ, Edis RH Aust NZ J Med 16:771-778
Jul 1986
A retrospective analysis of 661 patients with stroke proven by CT scan or autopsy was conducted to evaluate the frequency of disease presentation without specific localizing neurologic signs. Nineteen patients (four with cerebral hemorrhage and 15 with cerebral infarction) had behavioral abnormalities as their primary presenting feature with minimal, transient, or even absent neurologic findings. Nine patients demonstrated reversible acute delirium or organic personality disorders. Eight of the nine had a nondominant hemispheric lesion, and all demonstrated marked mood alterations, including paranoia, mania, emotional lability, and apathetic affect. Acute, irreversible dementia occurred in seven patients with predominantly right temporal and parietal lesions. This group had global impairment of cognitive ability involving memory, judgment, and abstract thought. Emotional lability, aggressiveness, and paranoia were typical of these patients. A final group of three patients developed delayed, intermittent behavioral abnormalities with hallucinations, delusions, and mania. All three developed EEG disturbances, two exhibiting epilepsy. The authors found the lesions involved in these 19 stroke patients usually located in the peri-Sylvian cortex of the nondominant hemisphere, accounting for the predominant emotional disorientation and paucity of limb neurologic abnormalities.
A prospective anonymous analysis of serum samples of
236/1094
Annals of Emergency Medicine
Michael Hunt, MD 16:9 September 1987