LO060: Diagnostic and prognostic value of hydronephrosis in emergency department patients with acute renal colic

Abstract

to CT head completion was 6 hours 50 minutes (sd 7:20) leaving an average of 4 hours 52 minutes awaiting these results. Ultimately 86% of patients were referred to a consultant of which 92% were to Psychiatry. Conclusion: This study of CT head scans for bizarre behavior ED presentations showed that the CT results did not change the clinical management of the patient. Furthermore, awaiting these results prolonged ED length of stay and delayed patient disposition. A prospective trial of a clinical decision tool for ordering CT head scans in these patients is warranted. Keywords: neuroimaging, medical clearance, emergency department LO060 Diagnostic and prognostic value of hydronephrosis in emergency department patients with acute renal colic G. Innes, MD, E. Grafstein, MD, A. McRae, MD, D. Wang, MSc, E. Lang, MD, J. Andruchow, MD, MSc; University of Calgary, Calgary, AB Introduction: Hydronephrosis is a marker of stone-related ureteral obstruction. Our objective was to assess the diagnostic and prognostic value of hydronephrosis in ED patients with renal colic. Methods: We used an administrative database to identify all renal colic patients seen in Calgary's four EDs in 2014. Research assistants reviewed imaging reports to identify proven ureteral stones, and to document hydronephrosis and stone size. Surgical interventions, ED and hospital visits within 60-days were collated from all regional hospitals. The primary outcome was sensitivity and specificity of hydronephrosis (moderate or severe) for detecting stones >5mm. We also assessed the association of hydronephrosis with index admission-intervention, and with outcomes at 7 and 60 days. Results: In 2014, 1828 patients had a confirmed ureteral stone plus assessment of hydronephrosis and stone size (1714 CT, 114 US). Hydronephrosis was absent, mild, moderate or severe in 15%, 47%, 34% and 4% of patients respectively. Median stone size was 4.0, 4.0, 5.0 and 7.0mm for patients in these categories. Mild, moderate and severe hydronephrosis were highly associated with admission (OR = 2.0, 4.6, 9.8; p < 0.001) and index visit surgical intervention (OR = 2.1, 3.7, 6.0; p < 0.001). The presence of moderatesevere hydronephrosis was 54.7% sensitive and 65.4% specific for stones > 5mm, with positive and negative predictive values of 51% and 74.2%. Of 1828 patients, 748 had an index visit surgical procedure and 1080 were discharged with medical management. In the latter group, hydronephrosis was absent, mild, moderate or severe in 20%, 50%, 27% and 3%. Corresponding median (IQR) stone size was 3.0, 4.0, 4.0 and 5.0mm. Of 1080 medically managed patients, 19% and 25% had an unscheduled ED revisit by 14 and 60 days, 9% and 10% were hospitalized by 7 and 60 days, and 13% had a rescue procedure within 60 days. In the medically managed group, degree of hydronephrosis had no statistical association with any outcomes at 7 or 60 days. Conclusion: Hydronephrosis has poor sensitivity, specificity and predictive value for stones > 5mm. Degree of hydronephrosis is highly associated with...