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Anderson T, Hopper C, MacCraith E, McCabe A, Shortt CP. Assessment of clinically significant urolithiasis positivity rate using CT KUB for suspected renal colic. Ir J Med Sci 2024; 193:1009-1013. [PMID: 37542633 DOI: 10.1007/s11845-023-03477-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/24/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Unenhanced low-dose computed tomography of the kidneys, ureter and bladder (CT KUB) is the gold standard diagnostic imaging modality in the assessment of suspected renal colic. As the radiation dose is not negligible, it is important to monitor the diagnostic yield of CT KUBs. The aim of this study is to evaluate the diagnostic yield of CT KUB studies performed for suspected renal colic in patients presenting to the emergency department. METHODS A retrospective review was performed of 500 patients who underwent CT KUB for suspected renal colic over a seven month period from June 2019 to January 2020. Clinical information and imaging was reviewed for each patient. Statistical analysis was performed using GraphPad Prism 8 (GraphPad Software, San Diego, CA, USA). RESULTS Forty-nine percent of patients in the series were female (248/500) and the mean age was 45. The positivity rate for obstructing ureteral calculus was 34% (169/500). Concerningly, there was a significantly lower positivity rate in females compared to males (19% versus 48%; p < 0.0001) which raises the issue of unnecessary radiation exposure to this cohort. In the 200 female patients who were negative for obstructing urolithiasis, the mean age was 43. Females also had a significantly higher rate of negative CT KUB (62% versus 37%; p < 0.0001) where no underlying alternative pathology was diagnosed. CONCLUSIONS Women are less likely than men to have obstructing urolithiasis on CT KUB for suspected renal colic. This difference is not accounted for by a higher rate of alternative diagnoses among female patients. The findings of this study should prompt clinicians to exercise caution when considering this imaging modality in this patient cohort.
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Wentz A, Wang R, Marshall B, Shireman T, Liu T, Merchant R. Opioid Analgesic Use After an Acute Pain Visit: Evidence from a Urolithiasis Patient Cohort. West J Emerg Med 2022; 23:864-871. [DOI: 10.5811/westjem.2022.8.56679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/13/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: Urolithiasis causes severe acute pain and is commonly treated with opioid analgesics in the emergency department (ED). We examined opioid analgesic use after episodes of acute pain.
Methods: Using data from a longitudinal trial of ED patients with urolithiasis, we constructed multivariable models to estimate the adjusted probability of opioid analgesic use 3, 7, 30, and 90 days after ED discharge. We used multiple imputation to account for missing data and weighting to account for the propensity to be prescribed an opioid analgesic at ED discharge. We used weighted multivariable regression to compare longitudinal opioid analgesic use for those prescribed vs not prescribed an opioid analgesic at discharge, stratified by reported pain at ED discharge.
Results: Among 892 adult ED patients with urolithiasis, 79% were prescribed an opioid analgesic at ED discharge. Regardless of reporting pain at ED discharge, those who were prescribed an opioid analgesic were significantly more likely to report using it one, three, and seven days after the visit in weighted multivariable analysis. Among those who were not prescribed an opioid analgesic, an estimated 21% (not reporting pain at ED discharge) and 30% (reporting pain at discharge) reported opioid analgesic use at day three. Among those prescribed an opioid analgesic, 49% (no pain at discharge) and 52% (with pain at discharge) reported using an opioid analgesic at day three.
Conclusion: Urolithiasis patients who received an opioid analgesic at ED discharge were more likely to continue using an opioid analgesic than those who did not receive a prescription at the initial visit, despite the time-limited nature of urolithiasis.
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Affiliation(s)
- Anna Wentz
- Brown University School of Public Health, Department of Epidemiology, Providence, Rhode Island
| | - Ralph Wang
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Brandon Marshall
- Brown University School of Public Health, Department of Epidemiology, Providence, Rhode Island
| | - Theresa Shireman
- Brown University School of Public Health, Health Services Policy & Practice, Providence, Rhode Island
| | - Tao Liu
- Brown University School of Public Health, Data & Statistics Core of Brown Alcohol Research Center on HIV (ARCH), Providence, Rhode Island
| | - Roland Merchant
- Harvard Medical School, Brigham and Women’s Hospital Department of Emergency Medicine, Boston, Massachusetts
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Are the Diagnosis and Treatment of Acute Cystitis in the Premenopausal, Pregnant, and Postmenopausal Women the Same? A Review of the Literature. Obstet Gynecol Surv 2022; 77:174-187. [PMID: 35275216 DOI: 10.1097/ogx.0000000000000993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Importance Acute cystitis is a common condition diagnosed in women. The diagnosis and treatment of this condition change throughout a woman's life. Understanding the differences in diagnosis and treatment in premenopausal, pregnant, and postmenopausal woman increases the likelihood of treatment success and decreases risk of complications from untreated or suboptimally treated infections. Objective The aim of this review is to describe the incidence, risk factor, pathophysiology, diagnosis, and management of acute cystitis and the similarities and differences of these aspects of the condition in the premenopausal, pregnant, and postmenopausal woman. Evidence Acquisition A PubMed, Web of Science, and CINAHL search was undertaken with the years 1990 to 2020 searched. Results There were 393 articles identified, with 103 being the basis of review. Multiple risk factors for acute cystitis have been identified and are largely consistent throughout a woman's lifetime with few exceptions. The diagnoses by group with common diagnostic tools, such as urinalysis, vary in specificity and sensitivity between these groups. Management also varies between groups, with pregnancy having specific limitations related to drug safety in regard to possible fetal effects posed by certain medications commonly used to treat acute cystitis. Conclusions Acute cystitis not only varies in presentation throughout a woman's lifespan, but also in appropriate diagnosis and treatment. Treatment of acute cystitis does have some commonalities between the groups; however, there are contraindications unique to each group. These differences are paramount to not only ensuring appropriate treatment but also treatment success. Relevance Acute cystitis is a common condition with different diagnostic and management recommendations throughout a woman's lifespan.
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Haimowitz M, Gonzalez L. Renal Vein Thrombosis on Point-of-care Ultrasound in the Emergency Department: A Case Report. Clin Pract Cases Emerg Med 2022; 6:17-20. [PMID: 35226840 PMCID: PMC8885229 DOI: 10.5811/cpcem.2021.9.53714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/20/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction This case report of renal vein thrombosis found on emergency bedside
ultrasound illustrates the expanding role of point-of-care ultrasound
(POCUS) in rapidly identifying rare renal pathologies. Case Report A 16-year-old female with a complex medical history presenting with
right-sided abdominal pain and tenderness was found to have significant
renal POCUS findings consistent with renal vein thrombosis. Conclusion In the medically complex patient with nonspecific chief complaints, it can be
challenging to rapidly narrow a broad differential diagnosis. Point-of-care
ultrasound has proven to be an extremely useful tool for this purpose. As
emergency physicians become more proficient in the use of ultrasonography,
it is likely that POCUS will be used with increasing frequency to identify
additional pathology outside its traditional applications.
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Affiliation(s)
- Michelle Haimowitz
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Laura Gonzalez
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
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Frumer M, Aharony SM, Shoshany O, Kedar D, Baniel J, Golan S. Trends in urological emergencies in the Era of COVID-19. Int Braz J Urol 2021; 47:997-1005. [PMID: 34260177 PMCID: PMC8321443 DOI: 10.1590/s1677-5538.ibju.2020.1092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/24/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate trends in emergency room (ER) urological conditions during COVID-19 pandemic lockdown. MATERIALS AND METHODS Retrospective analyses of renal colic, hematuria, and urinary retention in ER's admissions of a tertiary hospital during the lockdown period (March 19 to May 4, 2020) in Israel. Patient's demographics and clinical characteristics were compared to those in corresponding periods during 2017-2019, with estimated changes in ER arrival and waiting times, utilization of imaging tests, numbers of hospitalizations, and urgent procedure rates. RESULTS The number of ER visits for renal colic, hematuria, and urinary retention decreased by 37%, from an average of 451 (2017-2019) to 261 patients (2020). Clinical severity was similar between groups, with no major differences in patient's age, vital signs, or laboratory results. The proportion of ER visits during night hours increased significantly during lockdown (44.8% vs. 34.2%, p=0.002). There was a decrease in renal colic admission rate from 19.8% to 8.4% (p=0.001) without differences in urgent procedures rates, while the 30-day revisit rate decreased from 15.8% to 10.3% during lockdown (p=0.02). CONCLUSIONS General lockdown was accompanied by a significant decrease in common urological presentations to the ER. This change occurred across the clinical severity spectrum of renal colic, hematuria, and urinary retention. In the short term, it appears that patients who sought treatment did not suffer from complications that could be attributed to late arrival or delay in treatment. The long-term implications of abstinence from seeking emergent care are not known and require further investigation.
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Affiliation(s)
- Michael Frumer
- Rabin Medical CenterDepartment of UrologyPetach TikvaIsraelDepartment of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Shachar M. Aharony
- Rabin Medical CenterDepartment of UrologyPetach TikvaIsraelDepartment of Urology, Rabin Medical Center, Petach Tikva, Israel
- Tel Aviv UniversitySackler Faculty of MedicineTel AvivIsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Shoshany
- Rabin Medical CenterDepartment of UrologyPetach TikvaIsraelDepartment of Urology, Rabin Medical Center, Petach Tikva, Israel
- Tel Aviv UniversitySackler Faculty of MedicineTel AvivIsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Kedar
- Rabin Medical CenterDepartment of UrologyPetach TikvaIsraelDepartment of Urology, Rabin Medical Center, Petach Tikva, Israel
- Tel Aviv UniversitySackler Faculty of MedicineTel AvivIsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jack Baniel
- Rabin Medical CenterDepartment of UrologyPetach TikvaIsraelDepartment of Urology, Rabin Medical Center, Petach Tikva, Israel
- Tel Aviv UniversitySackler Faculty of MedicineTel AvivIsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shay Golan
- Rabin Medical CenterDepartment of UrologyPetach TikvaIsraelDepartment of Urology, Rabin Medical Center, Petach Tikva, Israel
- Tel Aviv UniversitySackler Faculty of MedicineTel AvivIsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Jha P, Bentley B, Behr S, Yee J, Zagoria R. Imaging of flank pain: readdressing state-of-the-art. Emerg Radiol 2016; 24:81-86. [PMID: 27614885 DOI: 10.1007/s10140-016-1443-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/05/2016] [Indexed: 10/21/2022]
Abstract
Pain resulting from renal and ureteral stones is a common cause for patients presenting in the acute setting. Since the late 1990s, computed tomography (CT) has been the initial imaging method of choice to evaluate patients with suspected ureteral stones; however, concerns regarding both radiation dose and cost-effectiveness have prompted investigations into a different imaging algorithm. Studies utilizing ultrasound have provided evidence indicating that it may be a more appropriate first step, with selective use of CT in selected cases, in the diagnostic work-up. Techniques have evolved with low-dose CT, dual-energy CT, and magnetic resonance urography emerging as useful in imaging of renal colic patients. This manuscript reviews the current literature on state-of-the-art imaging for acute flank pain and proposes a new imaging algorithm in the evaluation of patients with acute flank pain and suspected ureteral stones.
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Affiliation(s)
- Priyanka Jha
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 4150 Clement Street, Building 200, Rm 2A-166, San Francisco, CA, 94121, USA.
| | - Brian Bentley
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 4150 Clement Street, Building 200, Rm 2A-166, San Francisco, CA, 94121, USA
| | - Spencer Behr
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 4150 Clement Street, Building 200, Rm 2A-166, San Francisco, CA, 94121, USA
| | - Judy Yee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 4150 Clement Street, Building 200, Rm 2A-166, San Francisco, CA, 94121, USA.,San Francisco Veterans Administration Medical Center, San Francisco, CA, USA
| | - Ronald Zagoria
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 4150 Clement Street, Building 200, Rm 2A-166, San Francisco, CA, 94121, USA
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