NDLI: Management of macroscopic haematuria in the emergency department.

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Management of macroscopic haematuria in the emergency department.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Hicks, Derek Li, Chi-Ying
Description	Country affiliation: United kingdom Author Affiliation: Hicks D ( Department of Emergency Medicine, Whipps Cross University Hospital, Whipps Cross Road, Leytonstone, London E11 1NR, UK. dhicks@doctors.org.uk)
Abstract	Macroscopic haematuria is a commonly seen condition in the emergency department (ED), which has a variety of causes. However, most importantly, macroscopic haematuria has a high diagnostic yield for urological malignancy. 30% of patients presenting with painless haematuria are found to have a malignancy. The majority of these patients can be managed in the outpatient setting. This review of current literature suggests a management pathway that can be used in the ED. A literature search was done using Medline, PubMed and Google. In men aged >60 years, the positive predictive value of macroscopic haematuria for urological malignancy is 22.1%, and in women of the same age it is 8.3%. In terms of the need for follow-up investigation, a single episode of haematuria is equally important as recurrent episodes. Baseline investigation in the ED includes full blood count, urea and electrolyte levels, midstream urine dipstick, beta human chorionic gonadotrophin, and formal microscopy, culture and sensitivities. Treatment of macroscopic haematuria aims at RESP--Resuscitation, Ensuring, Safe and Prompt. Indications for admission include clot retention, cardiovascular instability, uncontrolled pain, sepsis, acute renal failure, coagulopathy, severe comorbidity, heavy haematuria or social restrictions. Discharged patients should drink plenty of clear fluids and return for further medical attention if the following occur: clot retention, worsening haematuria despite adequate fluid intake, uncontrolled pain or fever, or inability to cope at home. Follow-up by a urological team should be promptly arranged, ideally within the 2-week cancer referral target.
File Format	HTM / HTML
ISSN	14720205
e-ISSN	14720213
Journal	Emergency Medicine Journal
Issue Number	6
Volume Number	24
Language	English
Publisher	BMJ Publishing Group Ltd
Publisher Date	2007-06-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Discipline Emergency Discipline Medicine Emergency Medicine Hematuria Diagnosis Therapy Causality Diagnosis, Differential Etiology Metabolism Practice Guidelines As Topic Predictive Value Of Tests Urinalysis Urinary Catheterization Urologic Diseases Complications
Content Type	Text
Resource Type	Article
Subject	Emergency Medicine Critical Care and Intensive Care Medicine

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