THE SINGLE INDICATION FOR CYSTOGRAPHY IN BLUNT TRAUMA

To define the indications for cystography in blunt trauma, two studies were completed. First, a 15-month retrospective evaluation revealed 2 6 patients with bladder trauma. All 26 patients presented with gross h ematuria. This was followed by a randomized prospective study of all p atients with blunt trauma. Patients were randomized to be evaluated wi th cystography for any degree of hematuria or the diagnosis of pelvic fracture versus those to be evaluated only for the presence of gross h ematuria. Eleven patients had pelvic fractures and no hematuria. One h undred nine patients had microscopic hematuria and a 39 per cent incid ence of coexistent pelvic fractures. Thirty-one patients had gross hem aturia and a 26 per cent incidence of pelvic fracture. Bladder injurie s were seen only in this latter group. Cost analysis of the prospectiv e study revealed a potential savings of $26,322 if gross hematuria had been the sole indication for cystography in blunt trauma. This approa ch has potential cost savings and, more importantly, will not compromi se the quality of trauma care.