BACKGRAUND: Trauma is a leading cause of mortality and morbidity in the pediatric population. In many centers microhematuria is used as a screening tool for significant abdominal injury and as an indication for further imaging. Despite being a common practice, evidence regarding its role in children is mainly extrapolated from adults and based on few studies, most using direct microscopy rather than dipstick urinalysis.
OBJECTIVES: To evaluate the role of microhematuria as an indicator for significant abdominal injury in children.
METHODES: A retrospective review of children aged 0-16 years admitted due to motor vehicle accident or fall during the years 2010-2014, who have had urinalyses performed.
RESULTS: The charts of 685 children were reviewed. Microhematuria, diagnosed by urine stick was found in 108 children, of which 49(45%), 29(26%) and 30(27%) had small, moderate and large hematuria respectively. Forty-five of the children who had microhematuria underwent computed tomography (CT) scan. Positive finding was recorded in 19 of these patients. There was no association between the amount of blood in urine and a significant finding on CT scan (pearson value 3.867, df=2, p=0.145) the positive predictive value of microhematuria in general was 0.43, and was higher for large microhematuria 0.55. US exam was negative in 31 children with microhematuria. Medical or surgical intervention was indicated for 6 of those patients. There were no readmissions among the discharged patients.
CONCLUSIONS: The use of microhematuria based on dipstick urinalyses as an indicator for significant abdominal injury is of low yield.
