Impact of CT scan in patients with first episode of suspected nephrolithiasis

Ha, Michael; MacDonald, Russell D.

doi:10.1016/j.jemermed.2004.04.009

Cited by 40 publications

(24 citation statements)

References 13 publications

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“…The 2.6% rate of ''clinically significant pathology'' other than urinary tract stones that we have observed here is significantly lower than the 14.4% 6 and 18% 7 rates reported elsewhere. The higher rates reported in those studies have been used to recommend the routine use of CT for the diagnosis of suspected renal colic; however, their definition of significant pathology appears to include that requiring further workup such as ultrasonography or follow-up CT. We found a similar 13.1% rate of ''significant pathology'' using that definition (data not shown).…”

Section: Discussioncontrasting

confidence: 83%

“…Although a recent review article 4 and summary literature 5 also appear to agree, they do not specify which symptoms and signs can be used for this purpose. These references also highlight some previous literature that appears to show a high rate of significant alternative diagnosis on CT scans ordered for suspected renal colic, [6][7][8] information that clinicians likely use to justify CT scans that might not have been ordered otherwise. We conducted this retrospective observational study of patients who had a renal protocol CT scan to further explore these issues and to see if a similar prospective study was justified.…”

Section: Ré Sumémentioning

confidence: 88%

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Utility of computed tomography and derivation and validation of a score to identify an emergent outcome in 2,315 patients with suspected urinary tract stone

Aubrey‐Bassler

Lee

Barter

et al. 2013

CJEM

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Objective: Because a majority of urinary tract stones (UTSs) pass spontaneously and clinically significant alternative pathology is rare, we hypothesize that many computed tomographic (CT) scans to diagnose them are likely unnecessary. We sought to measure the impact of renal CT scans on resource use and to justify a prospective study to derive a score that predicts an emergent diagnosis in patients with suspected UTS by doing so in our retrospective series. Methods: We conducted a retrospective study of ED patients who had noncontrast CT of the abdomen for suspected UTS. A split-sample was used to derive and validate a score to predict the presence of an emergent diagnosis on CT. Results: Of the 2,315 patients (50.8% female, mean age 45 years), 49 (2.1%) had an emergent outcome observed on CT. An additional 12 (0.5%) patients had an urgent outcome and 239 (10.6%) had a urologic procedure within 8 weeks of the CT. Serum white blood cell count, highest temperature, urine red blood cell count, and the presence of abdominal pain were significant predictors of the primary outcome. A score derived using these predictors had a potential range of 22 (0.26% predicted risk, 0.5% actual risk of the outcome) to 6 (52% predicted risk). The score was moderately discriminatory with c-statistics of 0.752 (derivation) and 0.668 (validation) and accurate with Hosmer-Lemeshow statistics of 10.553 (p 5 0.228, derivation) and 9.70 (p 5 0.286, validation). Conclusions: A sensible, relevant score derived and validated on all patients presenting with symptoms suggestive of renal colic could be useful in reducing abdominal CT scan ordering. RÉ SUMÉObjectifs: Comme la plupart des calculs ré naux (CR) sont é vacué s spontané ment et que le nombre d'autres affections possibles cliniquement importantes est trè s faible, nous avons é mis l'hypothè se selon laquelle bon nombre des tomodensitomé tries (TDM) effectué es pour faciliter la pose du diagnostic sont probablement inutiles. Nous avons cherché à mesurer l'incidence des TDM ré nales sur l'utilisation des ressources et à justifier la pertinence d'une é tude prospective afin de dé river un ré sultat qui permettrait de poser un diagnostic pré visionnel d'affection né cessitant une intervention immé diate chez des patients chez qui l'on soupç onnait la pré sence de CR, et ce, en faisant de mê me dans notre sé rie ré trospective de cas. Mé thode: Nous avons mené une é tude ré trospective sur des patients examiné s au service des urgences, qui avaient subi une TDM abdominale sans injection de produit de contraste pour une é valuation de la pré sence pré sumé e de CR. Nous avons fractionné un é chantillon pour dé river et valider un ré sultat permettant de poser un diagnostic pré visionnel d'affection né cessitant une intervention immé diate à partir des images obtenues à la TDM. Ré sultats: Sur les 2,315 patients (femmes: 50.8%; â ge moyen: 45 ans), 49 (2.1%) ont obtenu, à la TDM, un ré sultat né cessitant une intervention immé diate; 12 autres patients (0.5%) ont obtenu un ré sultat...

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Section: Discussioncontrasting

confidence: 83%

Section: Ré Sumémentioning

confidence: 88%

Utility of computed tomography and derivation and validation of a score to identify an emergent outcome in 2,315 patients with suspected urinary tract stone

Aubrey‐Bassler

Lee

Barter

et al. 2013

CJEM

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“…29 However, one small prospective study suggested that CT provided a significant number of diagnoses that could be missed if imaging was not performed. 14 In the present study, there were 47 (5.8%) patients in whom a diagnosis other than ureterolithiasis was made on initial renal US. No serious missed diagnoses were identified within the 90-day follow-up period of the patients with normal results on US, raising the question as to the imperative of performing urgent CT.…”

Section: Discussionmentioning

confidence: 54%

The utility of renal ultrasonography in the diagnosis of renal colic in emergency department patients

Edmonds

Yan

Sedran

et al. 2010

CJEM

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Objective: Computed tomography (CT) is an imaging modality used to detect renal stones. However, there is concern about the lifetime cumulative radiation exposure attributed to CT. Ultrasonography (US) has been used to diagnose urolithiasis, thereby avoiding radiation exposure. The objective of this study was to determine the ability of US to identify renal colic patients with a low risk of requiring urologic intervention within 90 days of their initial emergency department (ED) visit. Methods: We completed a retrospective medical record review for all adult patients who underwent ED-ordered renal US for suspected urolithiasis over a 1-year period. Independent, double data extraction was performed for all imaging reports and US results were categorized as "normal," "suggestive of ureterolithiasis," "ureteric stone seen" or "disease unrelated to urolithiasis." Charts were reviewed to determine how many patients underwent subsequent CT and urologic intervention. Results: Of the 817 renal US procedures ordered for suspected urolithiasis during the study period, the results of 352 (43.2%) were classified as normal, and only 2 (0.6%) of these patients required urologic intervention. The results of 177 (21.7%) renal US procedures were suggestive of ureterolithiasis. Of these, 12 (6.8%) patients required urologic intervention. Of the 241 (29.5%) patients who had a ureteric stone seen on US, 15 (6.2%) required urologic intervention. The rate of urologic intervention was significantly lower in those with normal results on US (p < 0.001) than in those with abnormal results on US. Conclusion: A normal result on renal US predicts a low likelihood for urologic intervention within 90 days for adult ED patients with suspected urolithiasis.Keywords: renal colic, urolithiasis, urologic intervention, ultrasonography, emergency department RÉSUMÉObjectif : Le tomodensitogramme est une technique d'imagerie utilisée pour détecter les calculs rénaux. Cependant, on se préoccupe de l'exposition cumulative aux rayonnements associés aux appareils de tomodensitométrie. On utilise les échographies pour diagnostiquer l'urolithiase, évi-tant ainsi l'exposition aux rayonnements. L'objectif de cette étude était de déterminer la capacité des échographies à repérer les patients atteints de colique néphrétique et pré -sentant un faible risque de devoir subir une intervention urologique dans les 90 jours suivant leur visite à l'urgence. Méthodes : Nous avons réalisé une étude rétrospective des dossiers médicaux pour tous les patients adultes qui avaient subi, sur une période d'un an, une échographie rénale prescrite à l'urgence pour suspicion d'urolithiase. Nous avons procédé à l'extraction de données en double pour tous les rapports d'imagerie, et les résultats des échographies ont été classés ainsi : normaux, évocateurs d'une urolithiase, calcul rénal détecté, ou maladie non associée à une l'urolithiase. Nous avons examiné les dossiers médicaux pour déterminer combien de patients avaient subi ultérieurement une tomodensitométrie et une interventi...

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“…12,19,20 Ultrasonography is rarely used except in pregnancy and for children. 21 This study found that adverse events were rare when participating EPs felt a CT scan was not clinically indicated among adults ages 18 to 50 years with a first episode of suspected renal colic.…”

Section: Discussionmentioning

confidence: 99%

Adverse events are rare among adults 50 years of age and younger with flank pain when abdominal computed tomography is not clinically indicated according to the emergency physician

Epstein

Rosenberg

Samuel

et al. 2013

CJEM

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Objective: Many emergency physicians (EPs) order ''confirmatory'' abdominal computed tomography (CT) in young flank pain patients, despite a high clinical suspicion of renal colic and the risk of radiation exposure. We measured the adverse outcome rate among flank pain patients identified as not requiring abdominal CT by the EP on a data form, regardless of whether CT was eventually ordered. Our secondary objective was to describe diagnoses other than renal colic identified by CT in this population. Methods: We conducted a prospective observational study at two community EDs. We asked staff EPs to complete a data sheet on patients ages 18 to 50 years with a first episode of flank pain, recording 1) if the flank pain was consistent with renal colic and 2) if the EP felt abdominal CT was indicated. Adverse outcomes (defined a priori as urgent surgical procedures, disability, or death) were assessed by research assistants at 4 weeks using telephone follow-up and a hospital records search. Results: We enrolled 389 patients; 353 completed follow-up (91%). The average age was 38.8 years, and 72.0% were male. Of 212 patients identified in the ''CT not indicated'' group, 2 had another diagnosis identified (unruptured diverticulitis and a ruptured ovarian cyst), but none had adverse outcomes (95% CI 0-1.4). Conclusions: Adverse events were rare (, 1.5%) among patients , 50 years old with flank pain when CT was not required according to the clinical assessment of the EP. Future research should assess the adverse outcomes of withholding CT in low-risk patients using a larger patient sample. RÉ SUMÉObjectifs: De nombreux mé decins d'urgence (MU) demandent une tomodensitomé trie (TDM) abdominale de « confirmation » chez les jeunes patients qui ressentent une douleur du flanc, malgré une forte pré somption de colique né phré tique et le risque d'exposition au rayonnement. Nous avons mesuré le taux de ré sultats dé favorables parmi les patients qui ressentaient une douleur du flanc et chez qui une TDM abdominale n'é tait pas né cessaire selon le MU sur le formulaire de donné es, peu importe qu'une TDM ait é té demandé e plus tard ou non. L'objectif secondaire é tait de dé crire les autres diagnostics que celui de la colique né phré tique, ré vé lé s par la TDM chez les patients concerné s. Mé thode: Nous avons mené une é tude d'observation prospective, dans deux services d'urgence (SU) communautaires. Nous avons demandé aux MU de remplir une fiche de donné es sur les patients â gé s de 18 à 50 ans, chez qui il s'agissait de la premiè re crise de douleur du flanc, en notant 1) si la douleur du flanc é tait compatible avec la colique né phré tique et 2) si, à leur avis, la TDM abdominale é tait indiqué e. Les é vé nements indé sirables (dé finis a priori comme une intervention chirurgicale d'urgence, l'incapacité ou la mort) ont é té é valué s, au bout de 4 semaines, par des adjoints à la recherche, au moyen d'un entretien té lé phonique de suivi et d'un examen des dossiers mé dicaux hospitaliers. Ré sultats: Au total, 3...

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Impact of CT scan in patients with first episode of suspected nephrolithiasis

Cited by 40 publications

References 13 publications

Utility of computed tomography and derivation and validation of a score to identify an emergent outcome in 2,315 patients with suspected urinary tract stone

Utility of computed tomography and derivation and validation of a score to identify an emergent outcome in 2,315 patients with suspected urinary tract stone

The utility of renal ultrasonography in the diagnosis of renal colic in emergency department patients

Adverse events are rare among adults 50 years of age and younger with flank pain when abdominal computed tomography is not clinically indicated according to the emergency physician

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