From the Guidelines
The emergency department workup for hematuria after a motor vehicle collision (MVC) should prioritize a thorough trauma assessment with focused evaluation of the genitourinary system, including a CT scan with IV contrast as the gold standard for imaging, as recommended by the most recent guidelines 1. The workup should begin with a complete history and physical examination, followed by laboratory tests including urinalysis, complete blood count, and renal function tests.
- Key considerations in the workup include:
- Mechanism of injury
- Hemodynamic stability
- Presence of gross or microscopic hematuria
- Associated injuries Imaging is essential, with CT scan with IV contrast being the preferred modality, as it allows for accurate classification of the degree of injury and associated injuries 1.
- The use of CT scan with IV contrast is supported by the guidelines, which recommend its use in hemodynamically stable or stabilized patients with suspected renal injury 1. Hemodynamically unstable patients may require immediate surgical exploration, while stable patients with microscopic hematuria and no other concerning findings may be appropriate for outpatient follow-up.
- However, gross hematuria, hypotension, or significant mechanism of injury warrants comprehensive imaging and potential intervention, as recommended by the guidelines 1. The urgency of this workup is justified by the potential for life-threatening hemorrhage or urinary extravasation, which can lead to infection, abscess formation, or renal failure if not promptly identified and treated.
- Patients should be monitored for delayed complications including secondary bleeding, infection, or hypertension, and managed accordingly, with a multidisciplinary approach and consideration of institutional factors 1.
From the Research
Emergency Department Workup for Hematuria after MVC
The workup for hematuria in the emergency department, especially after a motor vehicle collision (MVC), involves a thorough history, physical examination, and laboratory tests to determine the cause and assess risk factors for malignancy 2, 3.
- The approach to the patient with hematuria should consider both life-threatening and benign processes, with most workup driven by a focused history and physical, including laboratory studies and diagnostic imaging 3.
- The cause of hematuria often originates in the genitourinary tract, and as long as the patient remains stable, they can be discharged with close outpatient follow-up 3.
- However, hematuria, especially in the elderly, frequently signals the presence of urologic malignancy, emphasizing the importance of a thorough workup 3.
Diagnostic Approach
The diagnostic approach for hematuria involves:
- A comprehensive history and focused physical examination to determine potential causes and assess risk factors for malignancy 2, 4.
- Laboratory studies to rule out intrinsic renal disease and imaging of the urinary tract to identify potential causes 2, 4.
- Referral to nephrology and urology subspecialists if no benign cause is found 2.
Considerations in Trauma Patients
In trauma patients with hemorrhagic shock, a circulation-first approach for resuscitation may be considered, prioritizing restoration of circulation before endotracheal intubation and positive pressure ventilation 5.
- This approach aims to improve survival and neurologic outcomes by targeting simultaneous resuscitation with immediate efforts to control hemorrhage and provide basic airway interventions while prioritizing volume resuscitation with blood products 5.