• A F Morey, A J Iverson, A Swan, W J Harmon, S S Spore, S Bhayani, and S B Brandes.
• Urology Service, Brooke Army Medical Center, Fort Sam Houston, Texas 78234-6360, USA.
• J Trauma. 2001 Oct 1;51(4):683-6.

PurposeThe purpose of this study was to establish guidelines for diagnostic imaging for bladder rupture in the blunt trauma victim with multiple injuries, in whom the delay caused by unnecessary testing can hamper the trauma surgeon and threaten outcome.MethodsWe undertook chart review (1995-1999) of patients with blunt trauma and bladder rupture at our four institutions and performed focused literature review of retrospective series.ResultsOf our 53 patients identified, all had gross hematuria and 85% had pelvic fracture. Literature review revealed similar rates.ConclusionThe classic combination of pelvic fracture and gross hematuria constitutes an absolute indication for immediate cystography in blunt trauma victims. Existing data do not support lower urinary tract imaging in all patients with either pelvic fracture or hematuria alone. Clinical indicators of bladder rupture may be used to identify atypical patients at higher risk. Patients with isolated hematuria and no physical signs of lower urinary tract injury may be spared the morbidity, time, and expense of immediate cystographic evaluation.

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