Prospective comparison of unenhanced spiral computed tomography and intravenous urogram in the evaluation of acute flank pain

Miller, O. Fred; Rineer, Scott K; Reichard, Scott R; Buckley, R. G.; Donovan, Murray S.; Graham, Ian; Goff, Walter B.; Kane, Christopher J.

doi:10.1016/s0090-4295(98)00368-9

Cited by 208 publications

(97 citation statements)

References 20 publications

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“…Data from CT imaging techniques would likely improve the estimation of calculus size and location, particularly with very small calculi. [36][37][38] Nevertheless, IVP was once the gold standard and is well known to be accurate in diagnosing urolithiasis. 26,[39][40][41] For this derivation study, the investigators determined at a planning consensus conference that a 95% CI of 91%-100% around a sensitivity of 100% was adequate for a decision rule to predict the need for urological intervention.…”

Section: Discussionmentioning

confidence: 99%

Predicting intervention in renal colic patients after emergency department evaluation

Papa

Stiell

Wells

et al. 2005

CJEM

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Objectives:There is no set of prospectively validated criteria to identify the emergency department (ED) patients with renal colic who are most likely to eventually have to undergo an intervention. This study prospectively assessed predictors of intervention in this patient population. Methods: This prospective cohort study included adult patients with renal colic who presented to 2 tertiary care hospital EDs. Patients had an 18-variable data form completed by an emergency physician and a radiological study to confirm urolithiasis. After discharge, patients were followed at 1 and 4 weeks to assess for intervention. The outcome criteria included the patient having had at least 1 of the following procedures performed: extracorporeal shockwave lithotripsy (ESWL), ureteroscopy, percutaneous nephrostomy or open surgery. Data were analyzed using appropriate univariate techniques, and those variables associated with intervention were combined using logistic regression analysis. Results: Over an 8-month period, 245 patients with confirmed urolithiasis were followed; 20% (95% confidence interval [CI] 15%-25%) eventually had a procedure to remove their calculi. Three variables were significantly correlated with having a procedure: i) size of calculus ≥ 6 mm (odds ratio [OR] 10.7, 95% CI 4.6-24.8), ii) location of calculus above mid-ureter (OR 6.9, 95% CI 3.0-15.9), and iii) Visual Analogue Scale score for pain at discharge from the ED ≥ 2 cm (OR 2.6, 95% CI 1.0-6.8). The area under receiver operating characteristic curve was 0.77 (95% C I 0.70-0.84) (p < 0.001). If all variables were present there was a 90% probability of the patient having an intervention performed within 4 weeks of discharge from the ED. Conversely, if none of the variables were present there was only a 4% probability of an intervention. Overall, the model had a sensitivity of 92% (95% CI 89%-96%) and a specificity of 63% (95% CI 57%-69%). Conclusions: This study has identified variables that could potentially be used to identify those renal colic patients who require an intervention after ED evaluation. Future studies will prospectively validate this model. RÉSUMÉObjectifs : Il n'existe pas d'ensemble de critères validés prospectivement pour identifier les patients reçus au département d'urgence pour une colique néphrétique qui sont les plus susceptibles EM ADVANCES • INNOVATIONS EN MU

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Section: Discussionmentioning

confidence: 99%

Predicting intervention in renal colic patients after emergency department evaluation

Papa

Stiell

Wells

et al. 2005

CJEM

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“…Intravenous urography provides structural and functional information, including location, size of stone, and degree and nature of obstruction, and can also visualize 80% of radiopaque stones [24]. Despite its usefulness, there are some undesirable aspects of intravenous urography, including radiation exposure, contrast reaction, and risk of nephrotoxicity [25].…”

Section: Patient and Methodsmentioning

confidence: 99%

Usefulness of Color Doppler for Non-dilatational Ureteral Stone

Sim¹

2017

The Journal of the Korea Contents Association

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“…Unenhanced CT has been found to have better diagnostic performance than IVP, with sensitivity and specificity rates over 95%. [3][4][5][6][7][8] These diagnostic performances are also significantly better than a diagnostic approach combining KUB radiography and ultrasonography, particularly for stones less than 5 mm in size. 6,7 For these reasons, the American College of Radiology recommends unenhanced CT as the technique of choice for renal stone imaging, 9 as do the American Urological Association 10 and the European Association of Urology.…”

Section: Ré Sumémentioning

confidence: 98%

Prevalence of alternative diagnoses in patients with suspected uncomplicated renal colic undergoing computed tomography: a prospective study

Pernet

Abergel

Parra

et al. 2015

CJEM

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Objectives: Unenhanced computed tomography (CT) has become a standard imaging technique for uncomplicated renal colic in many countries. The appropriate timing of CT imaging has not been established, and guidelines recommend that this imaging be performed between 1 and 7 days of presentation. The primary objective of this study was to determine the prevalence of alternative diagnosis identified with low-dose unenhanced CT in the emergency department (ED) in patients with suspected uncomplicated renal colic. Methods: This prospective single-centre study was carried out in a large university hospital ED. Over a 6-month period, all patients with clinically diagnosed renal colic and a plan to be discharged underwent low-dose unenhanced CT in the ED. Pregnant women, women of childbearing age not willing to have a pregnancy test, and patients who had already undergone diagnostic imaging were excluded. The primary outcome was the number and nature of the alternative diagnosis. Univariate analyses were performed to assess factors associated with the primary outcome. Results: A total of 178 patients were screened, and 155 underwent CT in the ED. The mean age was 42.2 years; 69% were male. The diagnosis of uncomplicated renal colic was confirmed in 118 participants (76%); 27 (17%) had an inconclusive CT scan. Overall, 10 patients (6%; 95% confidence interval [CI] 3-10) had an alternative diagnosis, 5 of whom were subsequently hospitalized. Conclusion: Low-dose unenhanced CT in the ED detects alternative diagnoses in 6% (95% CI 3-10) of patients with suspected uncomplicated renal colic, half of whom are subsequently hospitalized. Our prospective findings, which were similar to those reported in retrospective studies, are a potential argument for a systematic approach to ED imaging in suspected renal colic. Future research involving intervention and control groups would be helpful. RÉ SUMÉObjectif: La tomodensitomé trie (TDM) sans densification est devenue, dans de nombreux pays, une technique d'imagerie courante dans les cas de colique né phré tique sans complications. Toutefois, le moment propice pour faire passer cet examen n'est pas é tabli, et, d'aprè s les lignes directrices, l'examen devrait ê tre effectué entre le premier et le septiè me jour de la consultation. L'é tude avait pour objectif principal de dé terminer la pré valence d'autres diagnostics que celui de colique né phré tique sans complications, posé s dans des cas pré sumé s, à l'aide de la TDM sans densification à faible dose, au service des urgences (SU). Mé thode: Il s'agit d'une é tude prospective, unicentrique, qui a é té mené e dans un SU d'un important centre hospitalier universitaire. Sur une pé riode de 6 mois, tous les patients chez qui un diagnostic clinique de colique né phré tique avait é té posé et pour lesquels la sortie é tait pré vue ont passé une TDM sans densification à faible dose au SU. Les femmes enceintes, celles en â ge de procré er qui ne souhaitaient pas passer un test de grossesse et les patients qui avaient dé jà subi de...

show abstract

Prospective comparison of unenhanced spiral computed tomography and intravenous urogram in the evaluation of acute flank pain

Cited by 208 publications

References 20 publications

Predicting intervention in renal colic patients after emergency department evaluation

Predicting intervention in renal colic patients after emergency department evaluation

Usefulness of Color Doppler for Non-dilatational Ureteral Stone

Prevalence of alternative diagnoses in patients with suspected uncomplicated renal colic undergoing computed tomography: a prospective study

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