Determining the Diagnostic Value of Ultrasound and CT Scan in Diagnosing Kidney Damage in Patients with Blunt Abdominal and Pelvic Trauma

Abdominal trauma is one of the most common causes of death in trauma patients, occurring in 20% of cases. Kidney damage is the most common complication of non-penetrating abdominal trauma. In patients with abdominal trauma, it is important to diagnose and treat possible abdominal injuries. The presence of hematuria and clinical examinations often have little sensitivity and specificity to diagnose the intra-abdominal injury. Although Computed Tomography (CT) scan is the standard diagnostic method for abdominal trauma, it has its own drawbacks, including radiation. On the contrary, ultrasound is a cheaper, more repetitive, and non-invasive procedure. The present study aimed to determine the diagnostic value of Focused Assessment with Sonography for Trauma (FAST) scan and ultrasound by a radiologist in comparison with abdomen and pelvis CT scan with intravenous (IV) contrast in determining the severity of kidney damage in patients with microscopic hematuria due to non-penetrating abdominal and pelvic trauma.

This forward-looking study was conducted on patients with blunt abdominal trauma with hematuria in Hamadan Besat Educational and Medical Center in 2018 and 2019. The sampling was performed by census method based on inclusion and exclusion criteria. Patient demographic information, as well as accident information that led to abdominal trauma, were recorded in a checklist. All participants were trained by a third-year emergency medicine assistant and then by a third- or fourth-year radiology assistant via FAST ultrasound to diagnose free abdominal fluid. In the next step, all participants were examined after IV contrast injection using a CT scan device. Finally, the data were analyzed in SPSS software (version 22) using appropriate statistical methods.

In this study, 60 eligible patients, including 47 males (78.4%) and 13 females (21.6%), with a mean age of 36.75±17.81 years, were examined. The percentage of agreement between the FAST ultrasound findings performed in the emergency and radiology departments was 93.3%. The agreement between the two methods was significant, with a coefficient of 0.837 (P<0.001). Sensitivity (75 and 80), specificity (100 and 92.5), positive (100 and 84.2) and negative (88.8 and 90.2) predictive values, as well as the accuracy (91.6 and 88.3) of FAST ultrasound, in both emergency and radiology groups were acceptable in comparison with CT scan.

As evidenced by the obtained results, it can be concluded that ultrasound is a reliable tool for examining patients with abdominal trauma with suspected kidney damage.