Detection of Specific Injuries

The need to determine the existence of specific injuries is based on the clinical elements obtained in the history, physical examination, and plain films, and to some extent the age of the patient. Tab]e 2M54-1 lists some key elements that should prompt the consideration of further evaluation of renal tract injury. The approach to evaluation is dependent on the following: blunt versus penetrating trauma, the presence of hematuria and whether it is gross or microscopic, associated injuries, mechanism of injury, hemodynamic stability, and age of the patient.3 Each of these factors affects the approach somewhat. Renal injuries require staging for appropriate management (Table.254-2).4 Staging is usually accomplished through use of an imaging modality, but sometimes exploration is required (see below).

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