title: Disproportionate Acidosis After Traumatic Bladder Rupture: A Case-Control Study.
abstract: BACKGROUND
  Traumatic bladder injury is rare and often missed on initial evaluation. We sought to identify early markers of bladder injury with a high sensitivity.
  
  
  METHODS
  A retrospective review from 1999 to 2008.
  
  
  RESULTS
  There were 28 patients diagnosed with traumatic bladder injury. The most common mechanism was car accidents with pelvic fractures. 93% (26) of the patients presented with significant metabolic acidosis, without evidence of hemorrhagic shock. For intra- and extraperitioneal bladder ruptures, the mean hemoglobin level on arrival was 12.4 + 2.0 (range 9.0-16.0) and 11.4 + 1.9 (range 8.2-14.7). The average pH on arrival for intraperitoneal ruptures was 7.22 + 0.16 (range 6.86-7.37) and for extraperitoneal ruptures, 7.22 + 0.16 (range 6.85-7.37). The pH improved in all patients with intraperitoneal rupture after surgical repair, up to a mean of 7.27 + 0.11 (range 7.06-7.36, p = 0.5) within 12 h. Extraperitoneal ruptures recovered more quickly with a pH after catheter drainage of 7.34 + 0.04 (range 7.27-7.37, p = 0.1) within 12 h. The ISS for intraperitoneal and extraperitoneal ruptures were similar, 30 + 12 (range 13-57) and 32 + 13 (range 13-57, p = 0.7). A cohort of trauma patients, matched by ISS, age, and pelvic fracture, but without bladder rupture, was used for comparison. Their mean ISS was 30 + 10 (range 14-57). The average pH for this group on arrival was 7.33 + 0.11 (range 7.16-7.42), and 47% of these patients had a normal pH. There was a significant difference between the pH on arrival in the ruptured compared to the nonruptured cohort (intraperitoneal pH 7.22, p = 0.008, extraperitoneal pH 7.22, p = 0.02). Three patients died (mortality 10.7%).
  
  
  CONCLUSIONS
  Disproportionate acidosis in the trauma patient is a sensitive indicator of bladder injury, especially with a pelvic fracture or hematuria. Fully resuscitated patients with persistent acidosis and an appropriate mechanism should be evaluated for bladder injury.
authors.affiliation: Department of Surgery, Michigan State University, Lansing, MI, 48912, USA.
authors.forename: Subhash
authors.initials: S
authors.lastname: Reddy
authors.affiliation: Division of Trauma Surgery, Flint, MI, 48503, USA. heartandbones@yahoo.com.|Division of Trauma Surgery, 7 West Hurley Medical Center, One Hurley Plaza, Flint, MI, 48503, USA. heartandbones@yahoo.com.
authors.forename: John Alfred
authors.initials: JA
authors.lastname: Carr
keywords: Acidosis; Bladder injury; Bladder rupture; Pelvic fracture
references.citation: World J Surg. 2001 Dec;25(12 ):1592-6
references.pmid: 11775197
references.citation: Ann Emerg Med. 1991 Aug;20(8):845-7
references.pmid: 1854066
references.citation: J Urol. 2000 Jul;164(1):43-6
references.pmid: 10840421
references.citation: Urol Clin North Am. 2006 Feb;33(1):67-71, vi
references.pmid: 16488281
references.citation: J Urol. 1979 Dec;122(6):741-3
references.pmid: 513215
references.citation: Ann Biomed Eng. 2008 Oct;36(10):1735-43
references.pmid: 18670881
references.citation: JAMA. 1972 Jul 31;221(5):491-2
references.pmid: 5067954
references.citation: J Trauma. 2001 Oct;51(4):683-6
references.pmid: 11586159
references.citation: Br J Urol. 1987 Sep;60(3):217-22
references.pmid: 3676665
references.citation: J Trauma. 2006 Aug;61(2):410-21; discussion 421-2
references.pmid: 16917459
references.citation: Br J Surg. 1995 Jan;82(1):69-70
references.pmid: 7881962
references.citation: J Urol. 1999 Jul;162(1):51-2
references.pmid: 10379738
references.citation: Am J Surg. 2002 Aug;184(2):143-7
references.pmid: 12169358
references.citation: J Trauma. 2002 Aug;53(2):238-42; discussion 242-4
references.pmid: 12169928
references.citation: J Trauma. 2005 Mar;58(3):533-7
references.pmid: 15761348