A 19-year-old man was kicked in the abdomen during soccer practice four hours ago. He has no nausea or vomiting, vitals are stable, chest X-ray is normal, and point-of-care hemoglobin and hematocrit are normal. Which is the most appropriate next step?

• A. Observation only
• B. Urine Dipstick Test (Assess for Hematuria)
• C. Abdominal CT scan
• D. Urinalysis

Answer: (B)

After blunt abdominal trauma in a stable patient, the priority is to assess for potential renal or urinary tract injury. A quick way to do this is a urine dipstick test to detect blood in the urine. The presence of hematuria, whether visible or microscopic, raises concern for renal injury and helps decide if further imaging with CT is needed to define any contusion or laceration. Normal vital signs and a normal hemoglobin/hematocrit don’t rule out kidney injury, since bleeding can be limited and blood tests may appear normal early. If the dipstick is negative, careful observation may be sufficient; if positive, proceed to CT imaging to evaluate the kidneys and urinary tract.