A Prospective Comparative Study of Color Doppler Ultrasound with Twinkling and Noncontrast Computerized Tomography for the Evaluation of Acute Renal Colic

Abdel-Gawad, Mahmoud; Kadasne, Ravi; Elsobky, Emad; Ali-El-Dein, Bedeir; Monga, Manoj

doi:10.1016/j.juro.2016.03.175

Cited by 39 publications

(35 citation statements)

References 22 publications

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“…First, a randomized controlled trial by Smith-Bindman et al compared CT to ultrasound as initial imaging choice and found no increase in adverse outcomes in the ultrasound group and less overall radiation exposure [4]. Second, Abdel-Gawad et al demonstrated that the addition of the “twinkling effect” may increase the ability of ultrasound to detect kidney stones to nearly the same sensitivity as non-contrast CT scan [9]. …”

Section: Discussionmentioning

confidence: 99%

“…Despite such a high frequency of visits, controversy exists over the process of diagnosing obstructing kidney stones, as it has evolved over the past two decades [2–8]. Current evidence supports the use of both non-contrast CT and ultrasound [3,9–11]. The American College of Emergency Medicine’s “Choosing Wisely” recommendation states that clinicians should “avoid ordering CT of the abdomen and pelvis in young otherwise healthy emergency department (ED) patients (age <50) with known histories of kidney stones, or ureterolithiasis, presenting with symptoms consistent with uncomplicated renal colic,” but guidelines for the diagnosis of first-time kidney stones do not exist within the Emergency Medicine literature [12].…”

Section: Introductionmentioning

confidence: 99%

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The Diagnosis and Management of Patients with Renal Colic across a Sample of US Hospitals: High CT Utilization Despite Low Rates of Admission and Inpatient Urologic Intervention

et al. 2017

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ObjectivesSymptomatic ureterolithiasis (renal colic) is a common Emergency Department (ED) complaint. Variation in practice surrounding the diagnosis and management of suspected renal colic could have substantial implications for both quality and cost of care as well as patient radiation burden. Previous literature has suggested that CT scanning has increased with no improvements in outcome, owing at least partially to the spontaneous passage of kidney stones in the majority of patients. Concerns about the rising medical radiation burden in the US necessitate scrutiny of current practices and viable alternatives. Our objective was to use data from a diverse sample of US EDs to examine rates of and variation in the use of CT scanning, admission, and inpatient procedures for patients with renal colic and analyze the influence of patient and hospital factors on the diagnostic testing and treatment patterns for patients with suspected renal colic.MethodsWe conducted a retrospective cohort study of adult patients who received a diagnosis of renal colic via a visit to an ED at 444 US hospitals participating in the Premier Healthcare Alliance database from 2009–2011. We modeled use of CT, admission, and inpatient urologic intervention as functions of both patient characteristics and hospital characteristics.ResultsOver the 2-year period, 307,612 patient visits met inclusion criteria. Among these patients, 254,211 (82.6%) had an abdominal CT scan, with 91.5% being non-contrast (“renal protocol”) CT scans. Nineteen percent of visits (58,266) resulted in admission or transfer, and 9.8% of visits (30,239) resulted in a urologic procedure as part of the index visit. On multivariable analysis male patients, Hispanic patients, uninsured patients, and privately insured patients were more likely to have a CT scan performed. Older patients and those covered by Medicare were more likely to be admitted, and once admitted, white patients and privately insured patients were more likely to have a urologic intervention. Only hospital region was associated with variation in CT rates, and this variation was minimal. Region and size of the hospital were associated with admission rates, and hospitals with more practicing urologists had higher intervention rates.ConclusionsIn this dataset, the majority of patients did not require admission or immediate intervention. Despite this, the large majority received CT scans, in a cohort representing 15–20% of all US ED visits. The CT rate was minimally variable at the hospital level, but the admission rates varied 2-fold, suggesting that hospital-level factors affect patient management. The high rate of CT usage coupled with the low rate of immediate intervention suggests that further research is warranted to identify patients who are at low risk for an immediate intervention, and could potentially be managed with ultrasound alone, expectant management, or delayed CT.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Diagnosis and Management of Patients with Renal Colic across a Sample of US Hospitals: High CT Utilization Despite Low Rates of Admission and Inpatient Urologic Intervention

et al. 2017

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“…Die sonographische Darstellung des Harntrakts ist sicher, kann den Aufenthalt in der Notaufnahme signifikant verkürzen [5] und führt zudem zu keinem relevanten Zeitverlust bis zu einer eventuellen Intervention [6,7]. Der Farbdopplerultraschall eignet sich in der akuten Kolik für die initiale Diagnose eines Harnleitersteins und ist mit den Ergebnissen des Steinsuch-CT vergleichbar [8,9]. Der US führt zwar zu einer Überschätzung der Steingröße [10,11] aber über spezielle US-Einstellungen (S-Mode) und die Messung der Schallschattenbreite ist eine genauere, mit dem nativen CT vergleichbare Größenbestimmung möglich [12,13].…”

Section: Ultraschallunclassified

Aktualisierung der S2k-Leitlinie zur Diagnostik, Therapie und Metaphylaxe der Urolithiasis (AWMF Registernummer 043-025)

Seitz

Bach

Bader

et al. 2019

Urologe

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Zusammenfassung Die Zunahme des medizinischen Wissens, technische Neuerungen gemeinsam mit demographischem Wandel stellen eine Herausforderung an die Neukonzeption von Leitlinien und klinischen Studien dar. Die vorliegende S2k-Leitlinie, die sich ausschließlich mit Nieren- und Harnleitersteinen beschäftigt, soll die Behandlung von Harnsteinpatienten in Klinik und Praxis unterstützen, aber auch Patienteninformationen zur Urolithiasis geben. Die zunehmende interdisziplinäre Zusammenarbeit in der Steintherapie zeigt sich auch an der Anzahl beteiligter Fachgruppen und Arbeitsgemeinschaften in der Erstellung des neuen Leitlinienupdates. Die vorliegende, aus einem interdisziplinären Konsensusprozess hervorgegangene S2k-Leitlinie stellt die aktuellen Empfehlungen praxisnah dar und gibt Entscheidungshilfen für Diagnostik‑, Therapie- und Metaphylaxemaßnahmen auf Basis von Expertenmeinungen und verfügbaren Evidenzgrundlagen aus der Literatur.

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“…18 Abdel-Gawad and colleagues demonstrated in a prospective, radiologist blinded study of 815 patients that color Doppler ultrasound (CDU) was able to identify 97.1% of patients with ureteral stones, with an associated 97.2% sensitivity and 99% specificity. 19 A strength of this study was that multiple ultrasound machines were each able to reproduce the twinkling effect. These results may have been limited by an absence of evaluation of intra-and inter-observer variability, and these imaging studies require expertise in performing both graded compression of the ureter and interpreting this novel technique.…”

Section: Pediatric and Pregnant Patientsmentioning

confidence: 99%

Ultrasound Use in Urinary Stones: Adapting Old Technology for a Modern-Day Disease

Tzou

Usawachintachit

Taguchi

et al. 2017

Journal of Endourology

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Ultrasound has become a mainstay tool in urologists' armamentarium for the diagnosis and management of nephrolithiasis. From starting as a rudimentary form of imaging, it has come to play a more prominent role over time, paralleling evolution in ultrasound technology. Throughout the medical community there is a growing emphasis on reducing the amount of ionizing radiation delivered to patients during routine imaging. As such there has been a resurgence of interest in ultrasound given its lack of associated radiation exposure and proven effectiveness as a diagnostic and therapeutic imaging modality. Herein, we provide a review of the history of ultrasound, how the use of ultrasound is expanding in both diagnosis and treatment of urinary stone disease, and finally how promising applications of ultrasound are shaping the future of kidney stone management.

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A Prospective Comparative Study of Color Doppler Ultrasound with Twinkling and Noncontrast Computerized Tomography for the Evaluation of Acute Renal Colic

Cited by 39 publications

References 22 publications

The Diagnosis and Management of Patients with Renal Colic across a Sample of US Hospitals: High CT Utilization Despite Low Rates of Admission and Inpatient Urologic Intervention

The Diagnosis and Management of Patients with Renal Colic across a Sample of US Hospitals: High CT Utilization Despite Low Rates of Admission and Inpatient Urologic Intervention

Aktualisierung der S2k-Leitlinie zur Diagnostik, Therapie und Metaphylaxe der Urolithiasis (AWMF Registernummer 043-025)

Ultrasound Use in Urinary Stones: Adapting Old Technology for a Modern-Day Disease

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