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

Abstract

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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Characteristics of modern methods of diagnosis of urolithiasis

“…Алгоритми із застосуванням методів ехографії та доплерографії дозволяють значною мірою прискорити та спростити процес обстеження пацієнтів з симптомами ниркової коліки, легко диференціювати урологічні, гострі хірургічні, гінекологічні захворювання, виявити конкременти у сечоводі хворого, визначити наявність порушень уродінаміки, що потребують ургентної застосування рентгенологічних та інвазивних методик [9][10][11].…”