Imaging in Suspected Renal Colic: Systematic Review of the Literature and Multispecialty Consensus

Abstract

Background: Renal colic is common, and CT is frequently utilized when the diagnosis of kidney stones is suspected. CT is accurate but exposes patients to ionizing radiation and has not been shown to alter either interventional approaches or hospital admission rates. This multi-organizational transdisciplinary collaboration sought evidence-based, multispecialty consensus on optimal imaging across different clinical scenarios in patients with suspected renal colic in the acute setting.Methods: In conjunction with the American College of Emergency Physicians (ACEP) eQual network, we formed a nine-member panel with three physician representatives each from ACEP, the ACR, and the American Urology Association. A systematic literature review was used as the basis for a three-step modified Delphi process to seek consensus on optimal imaging in 29 specific clinical scenarios.Results: From an initial search yielding 6,337 records, there were 232 relevant articles of acceptable evidence quality to guide the literature summary. At the completion of the Delphi process consensus, agreement was rated as perfect in 15 (52%), excellent in 8 (28%), good in 3 (10%), and moderate in 3 (10%) of the 29 scenarios. There were no scenarios where at least moderate consensus was not reached. CT was recommended in 7 scenarios (24%), with ultrasound in 9 (31%) and no further imaging needed in 12 (45%).Summary: Evidence and multispecialty consensus support ultrasound or no further imaging in specific clinical scenarios, with reducedradiation dose CT to be employed when CT is needed in patients with suspected renal colic.

Evaluation, management, and analysis of demographic and radiological characteristics of patients with renal colic at a tertiary hospital in Somalia

“…A systematic review, multispecialty, evidence-based consensus in line with the American College of Emergency Physicians (ACEP) regarding imaging in renal colic suggests that ultrasound may provide adequate diagnostic information to guide initial treatment. The ACR recommends that CT is “usually appropriate” and ultrasound “may be appropriate” for diagnosing acute flank pain [12] . The European Association of Urologists (EAU) recommends non-contrast computed tomography (NCCT) as the initial radiologic modality for acute flank pain.…”

Renal colic imaging practice patterns in Ontario: A population-based study

“…In contrast, the American Urology Association (AUA) released clinical effectiveness protocols in the management of ureteral calculi in 2012 which states that a non-contrast CT is the preferred initial imaging study for the index patient (7). In keeping with most of these recommendations, a recent systematic review with multispecialty consensus concluded that CT may be avoided in many common clinical scenarios when uncomplicated renal colic is suspected (8).…”