Evaluation of Ultrasonography Prognostic Value in Comparison with CT scan in Diagnosis of Kidney Injuries in Patients with High Energy Trauma and Microscopic Hematuria

Introduction & Abdominal trauma is one of the major causes of mortality in human populations. The aim of this prospective study was to evaluate the predictive value of sonography versus CT scan in the detection of renal injuries in patients، with high energy blunt abdominal trauma and microscopic hematuria، who referred to emergency department of Shohadaye Tajrish hospital. This study included all 400 patients (279 males and 121 females)، with 15-65 old ages، who referred to the emergency department of Shohadaye Tajrish Hospital for high energy blunt abdominal trauma، between 2010 and 2012. Patients with gross hematuria، hemodynamic instability، past medical history of renal failure، contrast agent allergy، renal failure، pregnancy and other contraindication of contrast injection were excluded. Personal characteristics of the patients such as age، sex، cause and mechanism of trauma، severity of trauma and physical examinations were recorded. Then all patients were evaluated underwent، separately abdominal and pelvic spiral CT scanning with intravenous contrast and abdominal sonography by an experienced radiologist. The positive and negative results of sonography were compared to the findings of abdominal and pelvic CT scan، as a gold standard procedure. Of the 400 patients (with the mean age 25. 9±14. 1 years) who were admitted to the emergency department due to high energy trauma، renal damage was detected in 68 cases by CT scan (17%). In 8 patients (11. 8%)، bilateral renal injury and in 60 patients (88. 2%) unilateral renal injury was identified. According to the grading classification proposed by the American Association for the Surgery of Trauma (AAST)، the severity of injury (in 76 kidney) were diagnosed، by CT scan as grade І، ІІ، ІІІ، in 49 (64. 5%)، 20 (26. 3%) and 7 (9. 2%) respectively. According to ultrasonography results، renal damage was found in 61 cases (15. 2%). Signs of sub-capsular hematoma، laceration، perinephric hematoma and parenchymal hematoma were detected by ultrasound in 37)55. 2% (، 25) 37. 4% (، 3(4. 4%) and 2 (3%) respectively. Overall sensitivity and specificity of sonography versus CT scan in the detection of renal injury were calculated to be 52. 76 (68. 4%) and 309. 324 (95. 37%)، respectively، with a 52. 67 (77. 6%) positive predictive value and a 309. 333 (92. 7%) negative predictive value. Generally، according to the results of this study، the role of sonography as one of the primary diagnostic technique for the detection of renal injury، in the patients who are affected by high energy trauma and microscopic hematuria and with stable vital signs، is confirmed.