THE ONE-SHOT INTRAVENOUS PYELOGRAM - IS IT INDICATED IN UNSTABLE TRAUMA PATIENTS BEFORE CELIOTOMY

Although contrast studies are valuable in assessing renal function and identifying injury in trauma victims, we questioned the use of ''one- shot'' intravenous pyelograms (IVPs) in unstable patients. Retrospecti ve review of 926 IVPs performed over 4.5 years identified 239 preopera tive ''one-shot'' IVPs in patients for whom evaluation in the radiolog y suite was felt to be unsafe. Of these IVPs, 53 had abnormal findings and 183 had normal findings. Three patients' records were lost. In th e 53 patients with abnormal IVP results, injuries were confirmed at su rgery in 39. In three cases, an abnormal appearing IVP provided the on ly indication for renal exploration leading to nephrectomy or revascul arization. In the remaining 14 patients with abnormal IVPs, the kidney s were found to be normal at surgery. In the 183 patients with normal IVPs, 14 had injuries that required nephrectomy, renal vein ligation, renorrhaphy, or perinephric drainage. The IVP assessment of contralate ral renal function played no role in the decision to perform nephrecto my. Conclusions: Eight percent of patients with normal IVP findings ha d renal injuries not detected by ''one-shot'' IVP, and 26% of patients with abnormal IVP findings had no intraoperative evidence of renal in jury. Delaying definitive therapy to obtain a preoperative ''one-shot' ' IVP in an unstable patient is not warranted.