title: Assessment of urinary dipstick in patients admitted to an ED for blunt abdominal trauma.
abstract: BACKGROUND
  Clinicians still face significant challenge in predicting intra-abdominal injuries in patients admitted to an emergency department for blunt abdominal trauma. This study was thus designed to investigate the value of dipstick urinalysis in patients with blunt abdominal trauma.
  
  
  METHODS
  We performed a retrospective, multicenter, cohort study involving patients admitted to the emergency department for abdominal traumas, examined by means of urinary dipstick and abdominal CT scan. The primary endpoint was the correlation between microscopic hematuria detected via dipstick urinalysis (defined by the presence of blood on the dipstick urinalysis but without gross hematuria) and abdominal injury, as evidenced on CT scan.
  
  
  RESULTS
  Of the 100 included patients, 56 experienced microscopic hematuria, 17 gross hematuria, and 44 no hematuria. Patients with abdominal injury were more likely to present with hypovolemic shock (odds ratio [OR]: 8.4; 95% confidence interval [CI]: 2.7-26), abdominal wall hematoma (OR: 3.1; 95% CI: 1.2-7.9), abdominal defense (OR: 5.2; 95% CI: 1.8-14.5), or anemia (OR: 3.6; 95% CI: 1.2-10.3). Moreover, dipstick urinalysis was less likely to predict injury, with just 72.2% sensitivity (95% CI: 54.8-85.8), 53.1% specificity (95% CI: 40.2-65.7), and positive and negative predictive values of 46.4% (95% CI: 33.0-60.3) and 77.3% (95% CI: 62.2-88.5), respectively.
  
  
  CONCLUSIONS
  Dipstick urinalysis was neither adequately specific nor sensitive for predicting abdominal injury and should thus not be used as a key assessment component in patients suffering from blunt abdominal trauma, with physical exam and vital sign assessment the preferred choice.
authors.affiliation: Service des urgences, Pôle SAMU-SMUR-Urgences, CHU Gabriel Montpied, Clermont-Ferrand, France. Electronic address: fmoustafa@chu-clermontferrand.fr.
authors.forename: F
authors.initials: F
authors.lastname: Moustafa
authors.affiliation: Service des urgences, Pôle SAMU-SMUR-Urgences, CHU Gabriel Montpied, Clermont-Ferrand, France. Electronic address: charlotte.loze@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Loze
authors.affiliation: Direction de la Recherche Clinique et de l'Innovation, Département de Biostatistiques, CHU Gabriel Montpied, Clermont-Ferrand, France. Electronic address: bpereira@chu-clermontferrand.fr.
authors.forename: B
authors.initials: B
authors.lastname: Pereira
authors.affiliation: Service de radiologie, CHU Gabriel Montpied, Clermont-Ferrand, France. Electronic address: mavaz@chu-clermontferrand.fr.
authors.forename: M A
authors.initials: MA
authors.lastname: Vaz
authors.affiliation: Service des urgences, CH Aurillac, Aurillac, France. Electronic address: l.caumon@ch-aurillac.fr.
authors.forename: L
authors.initials: L
authors.lastname: Caumon
authors.affiliation: Service des urgences, Pôle SAMU-SMUR-Urgences, CHU Gabriel Montpied, Clermont-Ferrand, France. Electronic address: cperrier@chu-clermontferrand.fr.
authors.forename: C
authors.initials: C
authors.lastname: Perrier
authors.affiliation: Service des urgences, Pôle SAMU-SMUR-Urgences, CHU Gabriel Montpied, Clermont-Ferrand, France; Université d'Auvergne, Clermont-I, UFR de médecine, Clermont-Ferrand, France. Electronic address: jschmidt@chu-clermontferrand.fr.
authors.forename: J
authors.initials: J
authors.lastname: Schmidt
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000652:urine*; D000058:Accidental Falls; D000063:Accidents, Traffic; D000328:Adult; D000368:Aged; D000740:Anemia / Q000209:etiology; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology; D006417:Hematuria / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012769:Shock / Q000209:etiology; D014057:Tomography, X-Ray Computed; D014551:Urinary Tract / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging / Q000652:urine*
keywords: Blunt abdominal trauma; Emergency; Hematuria; Urinalysis