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Negative Urine Studies in Conjunction with Negative FAST Predict No Intra-Abdominal Injury in Adult Blunt Trauma Patients
*Maureen V Hill1, *Karina A Newhall1, *Priyam K Vyas2, Kurt K Rhynhart1, *J. David Mancini1, Eric D Martin1, Kenneth W. Burchard1
1Dartmouth Hitchcock Medical Center, Lebanon, NH;2Christiana Care Health System, Wilminton, DE
OBJECTIVE: We hypothesized that a negative FAST scan in conjunction with a negative urine dip and urinalysis (UA) for blood could identify adult blunt trauma patients without intra-abdominal injury.
DESIGN: Retrospective review
SETTING: Level 1 trauma center
PATIENTS: Adult blunt trauma patients who underwent CT of the abdomen and pelvis.
INTERVENTIONS: None
MAIN OUTCOME MEASURES: Patient demographics, FAST scan results, urine tests for blood, and injuries. IAI was defined as any intra-abdominal solid organ, hollow viscus, or vascular injury. Actionable IAI was defined as any grade III or IV splenic, hepatic, or renal injury, or any other solid organ, hollow viscus or vascular injury.
RESULTS: 900 patients’ records were reviewed; 894 (99.3%) underwent FAST. 60 patients (6.7%) had a positive FAST. 128 (14.3%) patients had an IAI and 74 (8.3%) had an actionable IAI. 37 (4.1%) patients required intervention. There were 121 patients with negative FAST, negative UA and negative urine dip. The negative predictive value (NPV) for no IAI with negative FAST, negative UA and negative dip was 96.1% (91.1-98.7%, 95% CI) and the sensitivity was 95.9% (90.6-98.6%). The NPV for no actionable IAI with negative FAST, negative UA and negative dip was 98.7% (92.7-99.97%) and the sensitivity was 99.2% (95.5-99.98%). The NPV for no IAI requiring intervention with negative FAST, negative UA and negative dip was 97.3% (85.8-99.9%) and the sensitivity was 99.2% (95.5-99.98%). 1 patient with an IAI required an intervention and had a negative FAST, UA and urine dip.
CONCLUSIONS: Urine tests negative for blood in conjunction with a negative FAST can assist in predicting the absence of IAI at time of blunt trauma presentation.
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