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Orosco E, Terai H, Lotterman S, Baker R, Friedman C, Watt A, Beaubian D, Grady J, Delgado J, Herbst MK. Point-of-care ultrasound associated with shorter length of stay than computed tomography for renal colic. Am J Emerg Med 2024; 79:167-171. [PMID: 38452429 DOI: 10.1016/j.ajem.2024.02.024] [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: 12/27/2023] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Despite similar diagnostic effectiveness for renal colic, computed tomography (CT) is more resource intensive than point-of-care ultrasound (PoCUS). We sought to compare Emergency Department (ED) length of stay (LOS) among patients with renal colic according to imaging modality utilized. We secondarily compared rates of infection, return ED visits, missed significant pathology, and urologic intervention. METHODS This was a 12-month (1/1/22-12/31/22) multi-site retrospective cohort study of all patients diagnosed with renal colic who presented to the ED on days when at least one patient had a billable renal PoCUS examination performed. Patients with a history of genitourinary malignancy, pregnancy, renal transplant, hemodialysis, single kidney, prior visit for renal colic in the previous 30 days, or an incomplete workup were excluded. Median ED LOS was compared using a Wilcoxon rank sum test, and the 95% confidence limits for the difference between medians was calculated. Secondary outcomes were compared using a Fisher's Exact test. RESULTS Of 415 patients screened, 325 were included for analysis: 150 had CT alone, 80 had PoCUS alone, 54 had PoCUS plus CT, and 41 had neither. Median LOS for PoCUS alone was 75.0 (95% CI 39.3-110.7) minutes shorter than CT alone (231.5 vs. 307.0 min, p < 0.0001). Similar rates of infection, return visits, and missed pathology occurred across all groups (p > 0.10). Urologic interventions were higher in the PoCUS plus CT (25.9%) group compared to CT alone (7.3%), PoCUS alone (2.5%), and neither (7.3%), p < 0.0001. CONCLUSION Among patients with renal colic, PoCUS was associated with shorter ED LOS compared to CT, without differences in infection rates, return visits, or missed pathology. Patients with PoCUS plus CT had a higher rate of urologic interventions, suggesting PoCUS may have a role in identifying patients who would most benefit from CT.
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Affiliation(s)
- Emily Orosco
- University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Hiromi Terai
- University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Seth Lotterman
- Hartford Hospital, Department of Emergency Medicine, Hartford, CT, United States of America
| | - Riley Baker
- University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Cade Friedman
- University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Aren Watt
- University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Drew Beaubian
- University of Connecticut School of Medicine, Department of Emergency Medicine, Farmington, CT, United States of America
| | - James Grady
- University of Connecticut School of Medicine, Department of Public Health Sciences, Farmington, CT, United States of America
| | - João Delgado
- Hartford Hospital, Department of Emergency Medicine, Hartford, CT, United States of America
| | - Meghan Kelly Herbst
- University of Connecticut School of Medicine, Department of Emergency Medicine, Farmington, CT, United States of America.
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Alrosan S, Abu-Jeyyab M, Alabbasi M, Baidoun H, Bani Yassin AR, Mansour S, Al-Rabadi Z, Aldiabat B, Jawazneh Y, Azzawi S, Alkatib M, Al Mse'adeen M. A Multicentric Audit to Reevaluate the Guidelines Adherence in Computed Tomography of Kidneys, Ureters, and Bladder (CT-KUB) X-ray Imaging in Jordan. Cureus 2024; 16:e53634. [PMID: 38449984 PMCID: PMC10917123 DOI: 10.7759/cureus.53634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Background With the increasing use of imaging techniques involving ionizing radiation, the area of the body scanned should be restricted to what is required to answer the clinical question. Therefore, this is a retrospective audit that intends to evaluate the presence of overscanning in renal computed tomography (CT) scan images during the process of evaluation for urinary symptoms. Objective This study aims to reduce the unnecessary scan length and exposure to radiation in patients who undergo CT scans for urinary symptoms. Materials and Methods In two months duration, patients from different clinics underwent CT imaging, and the resulting radiographic images were collected and analyzed. Overscanning was defined to be more than 10% of the total scan. Subsequently, the total length of the CT scan was measured which is used to measure the unnecessary overscan above the highest kidney margin as a percentage of the total length. Results Out of the 88 patients who were evaluated, 100% did not meet the guidelines for renal CT imaging and were exposed to a high radiation dose. However, the minimum percentage of overscanned patients was 20-40%. Conclusion A significant number of scans demonstrated surplus overscanning above the highest kidney. Therefore, recognizing the suitable anatomical landmarks for scanning and establishing a follow-up audit are suggested measures to minimize the noxious effects of radiation exposure.
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Affiliation(s)
- Sallam Alrosan
- Internal Medicine, Saint Luke's Health System, Kansas City, USA
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3
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Shetty M. Acute Pelvic Pain: Role of Imaging in the Diagnosis and Management. Semin Ultrasound CT MR 2023; 44:491-500. [PMID: 37832696 DOI: 10.1053/j.sult.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
Acute pelvic pain is defined as a new symptom that has been present for less than 3 months. It is a common symptom seen in 15%-24% of women and is the indication for 20% of laparoscopies and 2%-10% of outpatient gynecologic visits. The pregnancy status and correlation of the physical symptoms with clinical findings are important. Ultrasound is the imaging modality of choice, not only to diagnose gynecological causes, but also bowel or urinary tract related causes of pelvic pain. When an ultrasound scan is inconclusive, a computed tomography scan is the preferred means of additional imaging and is particularly useful in gastrointestinal and urogenital causes of pelvic pain. Gynecological causes of acute pelvic pain include uterine, tubal, or ovarian pathology; non-gynecological causes include bowel diseases, such as appendicitis and diverticulitis; urogenital causes such as ureteral, bladder stones, and urinary tract infection as well as vascular causes. Ultrasound imaging alone may provide a definitive diagnosis in underlying conditions that require prompt medical or surgical intervention in gynecological conditions, such as ovarian torsion, ectopic pregnancy, and non-gynecological condition, such as in acute appendicitis.
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Affiliation(s)
- Mahesh Shetty
- Department of Radiology, Baylor College of Medicine, Houston, TX.
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4
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Jayman J, Gibbs H, Mathias R, Epelman M, Ellsworth P. Progression of asymptomatic nephrolithiasis in children: How often should patients receive follow-up ultrasound imaging? J Pediatr Urol 2022; 18:25.e1-25.e8. [PMID: 34756785 DOI: 10.1016/j.jpurol.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The natural history of asymptomatic nephrolithiasis (AN) in children is not well defined. Furthermore, there is no guidance on the utility of repeated renal ultrasound evaluations in this same population. Follow-up ultrasound studies are often obtained as frequently as every 6 months. The goal of this study is to assess the follow-up ultrasound interval in the management of these patients. METHODS A retrospective IRB approved chart review was performed for patients seen for non-cysteine AN between 2012 and 2019. AN was defined as patients without obstructive uropathy abdominal, flank pain and/or gross hematuria. Asymptomatic stones were discovered incidentally or after an acute stone event. Patients with pre-existing renal anomalies and the timepoints with stone passage or stone procedure were excluded. Descriptive statistics were used for demographic information. Multiple linear regression was used to analyze risk factors. Statistical significance was set to p < 0.05. RESULTS Twenty-nine patients had 90 ultrasounds. The average age at diagnosis was 10.8 ± 6.2 years. The average number of ultrasound studies per patient was 3.2 ± 1.7. The median time between follow-up ultrasounds was 5.2 months [IQR 2.8-10.0]. Median follow-up of patients was 10.6 months [IQR 4.9-21.9]. The change in total stone burden occurred at a rate of 0.11 mm/month (CI [-0.06-0.28], p = 0.20, r2 = 0.42) or 0.66 mm/6 months. Patients with more renal stones had almost a threefold increase in stone burden compared to patients with fewer renal stones (2.98 [CI 1.34-4.62], p=0.001, r2=0.33). Patients with a family history of stones had a twofold increase in the size of their largest stone when compared to patients without a family history (1.97 [CI 0.26-3.68], p=0.02, r2=0.60. CONCLUSION A complex interplay of multiple factors influence the progression of AN in children. Children with a greater number of stones have a higher increase in total stone burden and children with a family history of stones have a faster increase in largest stone size. These patients may require more frequent imaging studies. The small change in stone size over time favors a longer than 6-month interval for many children.
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Affiliation(s)
- John Jayman
- University of Central Florida School of Medicine, Orlando, FL, USA
| | - Hannah Gibbs
- University of Central Florida School of Medicine, Orlando, FL, USA
| | - Robert Mathias
- Division of Nephrology, Nemours Children's Hospital, Nemours Healthcare System, Orlando, FL, USA
| | - Monica Epelman
- Division of Radiology, Nemours Children's Hospital, Nemours Healthcare System, Orlando, FL, USA
| | - Pamela Ellsworth
- Division of Pediatric Urology, Nemours Children's Hospital, Nemours Healthcare System, Orlando, FL, USA.
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Castelletto S, Amore G, Giudice CA, Orso D, Copetti R. A Preliminary Investigation on the “Swinging Kidney”: A Sonographic Sign Useful for Diagnosing Renal Colic. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793211073693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective: During acute renal colic due to nephrolithiasis, a new sonographic diagnostic sign was noted, called “a swinging kidney.” This term was given due to a characteristic anteroposterior “rolling” movement of the kidney. A preliminary investigation was conducted to evaluate the correlation between this new diagnostic sign and nephrolithiasis. Materials and Methods: An exploratory observational investigation was conducted on adult patients who accessed an emergency medicine department, with acute renal colic, between June 1, 2019, and October 31, 2019. Results: Thirty-seven patients were enrolled. The “swinging kidney” was present in 26 cases (70%). This sign was correlated with a stone’s diameter of less than 10 mm (χ2: 4.68; P = .031), and with a stone localization in the juxtavesical ureter tract site (χ2: 10.83; P = .029). Spontaneously stone expulsion was correlated with the presence of the “swinging kidney” (χ2: 4.66; P = .031); with the minor degree of hydronephrosis (χ2: 16.82; P = .0008), and with a distal localization of the stone (χ2: 25.11; P = 1:47 × 10−5). Conclusion: The “swinging kidney” may be a promising diagnostic sign that could be useful in diagnosing nephrolithiasis besides the other indirect sonographic signs. This new diagnostic sign could have a prognostic role.
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Affiliation(s)
- Silvia Castelletto
- Department of Emergency Medicine, ASUFC Community Hospital of Latisana, Latisana, Italy
| | - Giulia Amore
- Department of Emergency Medicine, ASUFC Community Hospital of Latisana, Latisana, Italy
| | - Caterina Anna Giudice
- Department of Emergency Medicine, ASUFC Community Hospital of Latisana, Latisana, Italy
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
| | - Roberto Copetti
- Department of Emergency Medicine, ASUFC Community Hospital of Latisana, Latisana, Italy
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Jackman SV, Maganty A, Wolfson AB, Burrows PK, MacPherson C, Vargas NM, Kirkali Z, Meltzer AC. Resolution of Hydronephrosis and Pain to Predict Stone Passage for Patients With Acute Renal Colic. Urology 2021; 159:48-52. [PMID: 34627871 DOI: 10.1016/j.urology.2021.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/01/2021] [Accepted: 09/16/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To study patients who presented to the Emergency Department with acute renal colic to determine if resolution of hydronephrosis and pain accurately predicts stone passage on follow-up CT. MATERIALS AND METHODS This is a secondary analysis of a multicenter prospective randomized clinical trial of patients diagnosed by computed tomography (CT) scan with a symptomatic ureteral stone < 9 mm in diameter. Participants were followed after randomization to evaluate for analgesic use and to assess stone passage and hydronephrosis on a repeat CT scan obtained at 29-36 days. RESULTS Four-hundred-three patients were randomized in the original study and patients were included in this analysis if they did not have surgery for stone removal and had a CT scan and information on pain medication at follow-up (N = 220). Hydronephrosis was detected in 181 (82%) on initial CT. At follow-up CT, 43 (20%) participants had a persistent ureteral stone. Of these patients, 36 (84%) had no pain, 26 (60%) did not have hydronephrosis, and 23 (53%) had neither pain nor hydronephrosis. Resolution of hydronephrosis was associated with stone passage (RR 4.6, 95% CI 1.9, 11.0), while resolution of pain was not (RR 1.1, 95% CI 0.9, 1.4). CONCLUSION In patients with urinary stone disease, stone passage is associated with resolution of hydronephrosis but not resolution of pain. In patients with persistent ureteral stones, neither pain nor hydronephrosis are consistently present. These findings have important implications on follow-up imaging of patients with urinary stone disease.
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Affiliation(s)
- Stephen V Jackman
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Avinash Maganty
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Allan B Wolfson
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Pamela K Burrows
- The George Washington University Biostatistics Center, Rockville, MD
| | - Cora MacPherson
- The George Washington University Biostatistics Center, Rockville, MD
| | - Nataly Montano Vargas
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Andrew C Meltzer
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC.
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7
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Testault I, Gatel L, Vanel M. Comparison of nonenhanced computed tomography and ultrasonography for detection of ureteral calculi in cats: A prospective study. J Vet Intern Med 2021; 35:2241-2248. [PMID: 34258789 PMCID: PMC8478021 DOI: 10.1111/jvim.16210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Radiographs and ultrasound (US) are the primary imaging modalities used to assess ureteral calculi in cats. Reports describing the use of nonenhanced computed tomography (CT) are scarce. HYPOTHESIS/OBJECTIVES To compare US and nonenhanced CT for detection, number and localization of ureteral calculi in cats. ANIMALS Fifty-one cats with at least 1 ureteral calculus, and 101 ureters. METHODS Prospective case series. All cats underwent an US followed by a nonenhanced CT. Cats were included in the study if at least 1 ureteral calculus was diagnosed on either modality. Number of calculi and their localization (proximal, middle, and distal) were recorded on both modalities. Pelvic dilatation and maximal ureteral diameter were recorded with US. RESULTS More calculi were detected by nonenhanced CT (126) compared to US (90), regardless of localization (P < .001). More ureters were affected on nonenhanced CT (70) compared to US (57; P < .001). The number of calculi detected was significantly different between US and nonenhanced CT in the proximal (P = .02) and distal ureteral region (P < .001). Bilateral calculi were more frequent with nonenhanced CT (19 cats) compared to US (9 cats; P < .001). A pelvic size superior to 5 mm and a maximal ureteral diameter value superior to 3 mm were always associated with ureteral calculi. CONCLUSIONS AND CLINICAL IMPORTANCE Computed tomography is an emerging imaging modality in cats with a suspected ureteral obstruction. Combination of CT and US can be beneficial for case management.
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Affiliation(s)
| | - Laure Gatel
- Centre Hospitalier Vétérinaire Pommery, Reims, France
| | - Maïa Vanel
- Centre Hospitalier Vétérinaire Atlantia, Nantes, France.,Anicura TRIOVet, Rennes, France
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8
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Ong CSH, Lu J, Tan YQ, Tan LGL, Tiong HY. Implementation of a Ureteric Colic Telemedicine Service: A Mixed Methods Quality Improvement Study. Urology 2021; 147:14-20. [PMID: 33091386 PMCID: PMC7573635 DOI: 10.1016/j.urology.2020.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the effectiveness of a telemedicine service for ureteric colic patients in reducing the number of unnecessary face-to-face consultations and shortening waiting time for appointments. METHODS A telemedicine workflow was implemented as a quality improvement study using the Plan-Do-Study-Act method. All patients presenting with ureteric colic without high-risk features of fever, severe pain, and hydronephrosis, were recruited, and face-to-face appointments to review scan results were replaced with phone consultations. Data were prospectively collected over 3 years (January 2017 to December 2019). Patient outcomes including the reduction in face-to-face review visits, time to review, reattendance and intervention rates, were tracked in an interrupted time-series analysis, and qualitative feedback was obtained from patients and clinicians. RESULTS Around 53.2% of patients presenting with ureteric colic were recruited into the telemedicine workflow. A total of 465 patients (46.2%) had normal scan results and 250 patients (24.9%) did not attend their scan appointments, hence reducing the number of face-to-face consultations by 71.1%. A total of 230 patients (22.9%) required subsequent follow-up with urology, while 61 patients (6.1%) were referred to other specialties. Mean (SD) time to review was 30.0 (6.2) days, 6-month intervention rate was 3.4% (n = 34) and unplanned reattendance rate was 3.2% (n = 32). Around 93.1% of patients reported satisfaction with the service. CONCLUSION The ureteric colic telemedicine service successfully and sustainably reduced the number of face-to-face consultations and time to review without compromising on patient safety. The availability of this telemedicine service has become even more important in helping us provide care to patients with ureteric colic in the current COVID-19 pandemic.
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Affiliation(s)
- Chloe Shu Hui Ong
- Department of Urology, National University Hospital, National University Health System, Singapore
| | - Jirong Lu
- Department of Urology, National University Hospital, National University Health System, Singapore.
| | - Yi Quan Tan
- Department of Urology, National University Hospital, National University Health System, Singapore
| | - Lincoln Guan Lim Tan
- Department of Urology, National University Hospital, National University Health System, Singapore
| | - Ho Yee Tiong
- Department of Urology, National University Hospital, National University Health System, Singapore
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9
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Alahmadi AE, Aljuhani FM, Alshoabi SA, Aloufi KM, Alsharif WM, Alamri AM. The gap between ultrasonography and computed tomography in measuring the size of urinary calculi. J Family Med Prim Care 2020; 9:4925-4928. [PMID: 33209823 PMCID: PMC7652115 DOI: 10.4103/jfmpc.jfmpc_742_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/11/2020] [Accepted: 07/21/2020] [Indexed: 12/30/2022] Open
Abstract
Objective Due to a lack of studies regarding the need for computed tomography (CT) in measuring the size of each urinary calculus before surgery, this study was conducted to elucidate the difference between ultrasonography (US) and CT in measuring the size of urinary stones. Methods A retrospective review of 100 stones from 83 patients. Each urinary stone was measured using both US and CT; both measurements were then compared. Results Of 83 patients, the mean age was 39.29 ± 23.76 years; 47 (56.62%) were male and 36 (43.37%) were female. Most of the urinary stones were <10 mm (50.0%) followed by 11-20 mm (42.0%), (P < 0.001). A cross-tabulation test revealed strong compatibility between US and CT in measuring the size of urinary stones (73.7% in stones <10 mm, 66.7% in stones 11-20 mm and 50% in stones >21 mm), (P < 0.001). Spearman's rho correlation test revealed strong compatibility between stone diameters measured by US and CT (r = 0.755), (P = 0 < 0.001). T-test for equality of means revealed no significant difference in the measured size using US and CT (mean = 11.80 ± 5.83 vs. 11.65 ± 6.59, respectively), mean difference = 0.15, and P = 0.865, 95% confidence interval: -1.584-1.884. Conclusion No significant difference in measuring the size of urinary stones using US and CT. However, US may slightly overestimate small stones in some cases.
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Affiliation(s)
- Ahmed Eid Alahmadi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawarah, Kingdom of Saudi Arabia
| | - Fawaz Mobasher Aljuhani
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawarah, Kingdom of Saudi Arabia
| | - Sultan Abdulwadoud Alshoabi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawarah, Kingdom of Saudi Arabia
| | - Khalid M Aloufi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawarah, Kingdom of Saudi Arabia
| | - Walaa M Alsharif
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawarah, Kingdom of Saudi Arabia
| | - Abdulrahman M Alamri
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawarah, Kingdom of Saudi Arabia
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10
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Merhav G, Razi N. Risk Factors Predicting the Necessity of Renal Ultrasound in the Emergency Department. J Clin Imaging Sci 2020; 10:71. [PMID: 33194313 PMCID: PMC7656029 DOI: 10.25259/jcis_106_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/26/2020] [Indexed: 12/03/2022] Open
Abstract
Objectives: Renal ultrasound (US) is widely used for diagnosing renal pathologies, though few of them, such as obstructive uropathy, require emergent urological intervention. During on-call hours, when medical staff is limited, it is important to prioritize which renal US examinations will be done. The aim of this study was to evaluate patient risk factors to predict the necessity of emergent renal US in the emergency department (ED). Material and Methods: All adult patients referred for renal US from the ED, during on-call hours from May 2015 to April 2017, were retrospectively included. The mean age was 64 years (18–98). Data were collected from the patients’ medical records. Urological intervention performed within the first 24 h following the US examination was recorded. Multivariate analysis was performed. Results: About 66% of the patients did not have a permanent urethral catheter, history of renal stones, or known abdominal or pelvic mass. None of these patients required an urgent urological intervention. The receiver operating characteristic curve was calculated at 0.883, 95% CI (0.84–0.92). Conclusion: Using only three variables, we can greatly reduce the number of renal US examinations done at on-call hours allowing for prioritization of only the necessary examinations.
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Affiliation(s)
- Goni Merhav
- Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel
| | - Nira Razi
- Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology Haifa, Israel
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11
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Thungkatikajonkit P, Wongwaisayawan S, Wibulpolprasert A, Viseshsindh W, Kaewlai R. Is Combined Ultrasound with Radiography Sufficient for the Diagnosis of Obstructive Ureteric Stone in Patients with Acute Flank Pain? J Med Ultrasound 2020; 28:86-91. [PMID: 32874866 PMCID: PMC7446686 DOI: 10.4103/jmu.jmu_49_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/17/2019] [Accepted: 08/01/2019] [Indexed: 12/23/2022] Open
Abstract
Context Ultrasound (US) is excellent for detection of hydronephrosis but has poor sensitivity for stone detection. In contrast, radiography of the kidney-ureter-bladder has better sensitivity for detection of stone but limited sensitivity for hydronephrosis detection. A combination of these two modalities may improve both sensitivity and specificity for the diagnosis of obstructive ureteric stone. Aims This study aims to investigate the diagnostic accuracy of combined US with radiography for the diagnosis of obstructive ureteric stone in adult patients. Settings and Design Retrospective study with retrospective data collection performed in a 1500-bed university hospital. Materials and Methods A total of 90 patients were included. The electronic medical record, radiological reports, laboratory results, and patient management were extracted and analyzed. Statistical Analysis Used The diagnostic performance of US, radiography, and combined US with radiography were calculated and compared. The computed tomography was used as diagnostic reference. Results US alone had a sensitivity of 73.5%, specificity of 92.7%, and negative predictive value (NPV) of 74.5% for hydronephrosis. When US showed both ureteric stone and hydronephrosis, sensitivity dropped to 14.3% but specificity increased to 100%. Radiography alone had a sensitivity of 34.7%, specificity of 100%, and NPV of 56.2% for the detection of ureteric stone. Combining radiography with US raised the sensitivity for diagnosis of obstructive ureteric stone to 88% with a specificity of 93% and accuracy of 90%. Conclusions Combined US with radiography was accurate for the diagnosis of obstructive ureteric stone in patients presenting with acute flank pain.
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Affiliation(s)
- Pornprom Thungkatikajonkit
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirote Wongwaisayawan
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Arrug Wibulpolprasert
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wit Viseshsindh
- Department of Surgery, Division of Urology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rathachai Kaewlai
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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12
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Saw JTS, Imeri NN, Aldridge ES, Buntine PG. Predictive values of haematuria and hydronephrosis in suspected renal colic: An emergency department retrospective audit. Emerg Med Australas 2020; 32:573-577. [DOI: 10.1111/1742-6723.13462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 12/21/2019] [Accepted: 12/29/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Paul G Buntine
- Eastern Health Melbourne Victoria Australia
- Monash University Melbourne Victoria Australia
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13
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Schmid E, Leeson K, Xu KT, Richman P, Nwosu C, Carrasco L. CT imaging history for patients presenting to the ED with renal colic--evidence from a multi-hospital database. BMC Emerg Med 2019; 19:24. [PMID: 30823896 PMCID: PMC6397471 DOI: 10.1186/s12873-019-0232-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 02/04/2019] [Indexed: 11/13/2022] Open
Abstract
Background Patients with renal colic have a 7% chance of annual recurrence. Previous studies evaluating cumulative Abbreviations: computed tomography (CT) exposure for renal colic patients were typically from single centers. Methods This was an observational cohort study. Inner-city ED patients with a final diagnosis of renal colic were prospectively identified (1/10/16–10/16/16). Authors conducted structured electronic record reviews from a 6-hospital system encompassing over 192,000 annual ED visits. Categorical data analyzed by chi-square; continuous data by t-tests. Primary outcome measure was the proportion of study group patients with prior history CT abdomen/pelvis CT. Results Two hundred thirteen patients in the study group; 59% male, age 38+/− 10 years, 67% Hispanic, 62% prior stone history, flank pain (78%), dysuria (22%), UA (+) blood (75%). 60% (95% CI = 53–66%) of patients received an EDCV CT; hydronephrosis seen in 55% (95% CI = 46–63%), stone in 90%(95% CI = 83–94%). No significant differences observed in the proportion of EDCV patients who received CT with respect to: female vs. male (62% vs. 56%; p = 0.4), mean age (37+/− 9 years vs. 39+/− 11 years; p = 0.2), and Hispanic vs. non-Hispanic white (63% vs.63%; p = 0.96). Patients with a prior stone history were more likely than those with no history to receive an EDCV CT (88% vs. 16%; p < 0.001). 118 (55%; 95% CI = 49–62%) of patients had at least one prior CT, 46 (22%; 95% CI = 16–28%) had ≥3 prior CTs; 29 (14%; 95% CI = 10–19%), ≥ 10 prior CTs. Patients who did not receive an EDCV CT had a significantly higher mean prior number of CTs than those who had EDCV CT (5.1+/− 7.7 vs 2.2+/− 4.9; p < 0.001). Patients with prior stone were more likely to receive only U/S during EDCV (33% vs. 15%; p = 0.003). Conclusions Within our EDCV cohort of renal colic patients, 55% had at least one prior CT. The mean number of prior CTs was lower for patients receiving CT on EDCV, and Ultrasound (US) alone was used more often in patients with prior stone history vs. those with no prior history.
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Affiliation(s)
- Emily Schmid
- Department of Emergency Medicine, CHRISTUS Health/Texas A&M School of Medicine, Corpus Christi, TX, USA
| | - Kimberly Leeson
- Department of Emergency Medicine, CHRISTUS Health/Texas A&M School of Medicine, Corpus Christi, TX, USA
| | - K Tom Xu
- Texas Tech University School of Medicine, Bullock, Lubbock, TX, USA
| | - Peter Richman
- Department of Emergency Medicine, CHRISTUS Health/Texas A&M School of Medicine, Corpus Christi, TX, USA. .,CHRISTUS HEALTH/Texas A&M Residency in Emergency Medicine, 600 Elizabeth Street, Corpus Christi, TX, 78404, USA.
| | - Crystal Nwosu
- Department of Emergency Medicine, CHRISTUS Health/Texas A&M School of Medicine, Corpus Christi, TX, USA
| | - Lynn Carrasco
- Department of Emergency Medicine, CHRISTUS Health/Texas A&M School of Medicine, Corpus Christi, TX, USA
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Nery DR, Costa YB, Mussi TC, Baroni RH. Epidemiological and imaging features that can affect the detection of ureterolithiasis on ultrasound. Radiol Bras 2018; 51:287-292. [PMID: 30369654 PMCID: PMC6198834 DOI: 10.1590/0100-3984.2017.0113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To identify, in patients with clinical suspicion of ureterolithiasis,
epidemiological and imaging features that affect calculus detection on
ultrasound, as well as to compare ultrasound with multidetector computed
tomography (MDCT). Materials and Methods We searched our database for patients who underwent ultrasound, followed by
MDCT (if the ultrasound was negative), for suspected ureterolithiasis in an
emergency setting. Patients were divided into three groups: positive
ultrasound (US+); negative ultrasound/positive MDCT (US−/MDCT+); and
negative ultrasound/negative MDCT (US−/MDCT−). We evaluated age, gender,
ureterolithiasis laterality, location of the calculus within the ureter,
body mass index, calculus diameter, and calculus attenuation on MDCT. Results Of a total of 292 cases of suspected ureterolithiasis, 155 (53.1%) were in
the US+ group, 46 (15.7%) were in the US−/MDCT+ group, and 91 (31.2%) were
in the US−/MDCT− group. There were no significant differences among the
groups in terms of age, gender, ureterolithiasis laterality, and mean MDCT
attenuation values. Distal ureterolithiasis was most common in the US+
group, and calculi at other ureteral locations were more common in the
US−/MDCT+ group. The mean body mass index was significantly higher in the
US−/MDCT+ group than in the US+ group, and the mean calculus diameter was
significantly greater in the US+ group than in the US−/MDCT+ group. Conclusion A high body mass index, large calculus diameter, and calculus location in the
distal third of the ureter are the major factors favoring ureterolithiasis
detection on ultrasound.
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Affiliation(s)
- Daniela Rebouças Nery
- Hospital Universitário Professor Edgard Santos - Universidade Federal da Bahia (UFBA) e Delfin Medicina Diagnóstica, Salvador, BA, Brazil
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Alshoabi SA. Association between grades of Hydronephrosis and detection of urinary stones by ultrasound imaging. Pak J Med Sci 2018; 34:955-958. [PMID: 30190760 PMCID: PMC6115544 DOI: 10.12669/pjms.344.14602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To correlate between hydronephrosis grades and detection of urinary stones by B-mode ultrasound imaging. Methods: This study included 210 ultrasound reports of patients who underwent abdominal ultrasound imaging in the period from 1st January 2016 to 31st October 2017, and diagnosed as hydronephrosis. Data collected from the ultrasound reports. The detection rates of stones using B-mode ultrasound imaging compared in different grades of hydronephrosis. Chi-square test and Odds Ratio (OR) were performed to assess the relationship between variables. Results: Of 210 patients, hydronephrosis was unilateral in 91.8% of patients and bilateral in 8.1%. It was distributed in grade 2, grade 3, grade 1 and grade 4 in 58.57%, 20%, 12.38% and 9.1% of the patients respectively. B-mode ultrasound imaging determined the cause of hydronephrosis in 65.2% of cases. Urinary stones were the cause in 60% of the patients. The detection rate of urinary stones was 50%, 61% and 71.4% for grades 1, 2 and 3 hydronephroses respectively. On simple logistic regression analysis, urinary stones detected in Grade-3 were four times more compared to that in grade 4 (P=0.016) (OR 4.125, 95% CI 1.29-13.136%). Conclusion: Detection of urinary stones as the cause of hydronephrosis increases with increasing the grade of hydronephrosis from Grade-I to Grade-III and decrease in Grade-IV. Urinary stones were the cause of hydronephrosis in 60% of the patients in this study.
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Affiliation(s)
- Sultan Abdulwadoud Alshoabi
- Dr. Sultan Abdulwadoud Alshoabi, MBBS, MD. Arab board and Jordanian Board of Radiology, Assistant Professor of Radiology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah, Saudi Arabia
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Hsi RS, Schlunk SG, Tierney JE, Dei K, Jones R, George M, Karve P, Duddu R, Byram BC. Feasibility of non-linear beamforming ultrasound methods to characterize and size kidney stones. PLoS One 2018; 13:e0203138. [PMID: 30153279 PMCID: PMC6112662 DOI: 10.1371/journal.pone.0203138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/15/2018] [Indexed: 12/04/2022] Open
Abstract
Purpose Ultrasound methods for kidney stone imaging suffer from poor sensitivity and size overestimation. The study objective was to demonstrate feasibility of non-linear ultrasound beamforming methods for stone imaging, including plane wave synthetic focusing (PWSF), short-lag spatial coherence (SLSC) imaging, mid-lag spatial coherence (MLSC) imaging with incoherent compounding, and aperture domain model image reconstruction (ADMIRE). Materials and methods The ultrasound techniques were evaluated in an in vitro kidney stone model and in a pilot study of 5 human stone formers (n = 6 stones). Stone contrast, contrast-to-noise ratio (CNR), sizing, posterior shadow contrast, and shadow width sizing were compared among the different techniques and to B-mode. CT imaging within 60 days was considered the gold standard stone size. Paired t-tests using Bonferroni correction were performed to evaluate comparing each technique with B-mode. Results Mean CT measured stone size was 6.0mm (range 2.9–12.2mm) with mean skin-to-stone distance 10.2cm (range 5.4–16.3cm). Compared to B-mode, stone contrast was best with ADMIRE (mean +12.2dB), while SLSC and MLSC showed statistically improved CNR. Sizing was best with ADMIRE (mean +1.3mm error), however this was not significantly improved over B-mode (+2.4mm). PWSF performed similarly to B-mode for stone contrast, CNR, SNR, and stone sizing. In the in vitro model, the shadow contrast was highest with ADMIRE (mean 10.5 dB vs 3.1 dB with B-mode). Shadow sizing was best with SLSC (mean error +0.9mm ± 2.9), however the difference compared to B-mode was not significant. Conclusions The detection and sizing of stones are feasible with advanced beamforming methods with ultrasound. ADMIRE, SLSC, and MLSC hold promise for improving stone detection, shadow contrast, and sizing.
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Affiliation(s)
- Ryan S. Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
| | - Siegfried G. Schlunk
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Jaime E. Tierney
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Kazuyuki Dei
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Rebecca Jones
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Mark George
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Pranav Karve
- Department of Civil and Environmental Engineering, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Ravindra Duddu
- Department of Civil and Environmental Engineering, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Brett C. Byram
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, United States of America
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Bulbul E, Sener EF, Gunay NE, Taslidere B, Taslidere E, Koyuncu S, Gunay N. A role of the endothelial nitric oxide system in acute renal colic caused by ureteral stone. Am J Emerg Med 2017; 36:266-270. [PMID: 28802544 DOI: 10.1016/j.ajem.2017.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND AIMS Endothelial nitric oxide synthase gene polymorphisms play a role in some pathophysiological processes. In this study, the possible effects of endothelial nitric oxide synthase gene polymorphisms on ureteral stone disease in patients who were admitted to the emergency department with severe pain due to renal colic are examined. MATERIALS AND METHODS The study groups were designed as controls and patients. The control group was formed from the healthy volunteers who applied to the blood center next to the emergency service. The patient group comprised patients who were diagnosed with ureteral stone disease with severe pain. All of the genetic studies were based on extracted peripheral blood samples using the necessary procedures from the Genome and Stem Cell Center at Erciyes University (GENKOK). The data were analyzed with SPSS (IBM, ver 20, United Sate). RESULTS The study group comprised 62 females and 138 males, and the control group comprised 64 females and 136 males. All of the stones that caused renal colic were found to be localized in the ureters and the ureterovesical junction. The genotypes of the intron 4 polymorphism were found to be as follows: 4a/4a in 10 people, 4b/4a in 115, and 4b/4b in 275 people. The GG genotype of the eNOS-G894T polymorphism was found in 108 patients in the study group and in117 of the healthy individuals. There was no statistically significant difference between the two groups regarding these data. CONCLUSION Although this study is the first in the literature to examine the relationship between renal colic and endothelial nitric oxide synthase gene polymorphisms, our study demonstrated that no relation was found.
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Affiliation(s)
- Emre Bulbul
- Kayseri Training and Research Hospital, Department of Emergency Medicine, Kayseri, Turkey
| | - Elif Funda Sener
- Erciyes University, Faculty of Medicine, Department of Medical Biology, Kayseri, Turkey
| | - Nahide Ekici Gunay
- Kayseri Training and Research Hospital, Department of Clinical Biochemistry, Kayseri, Turkey
| | - Bahadir Taslidere
- Bezmialem Vakif University, Faculty of Medicine, Department of Histology and Embryology, İstanbul, Turkey
| | - Elif Taslidere
- Malatya State Hospital, Department of Emergency Medicine, Malatya, Turkey
| | - Serhat Koyuncu
- Gaziosmanpasa University, Faculty of Medicine, Department of Emergency Medicine, Tokat, Turkey.
| | - Nurullah Gunay
- Erciyes University, Faculty of Medicine, Department of Emergency Medicine, Kayseri, Turkey
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The Diagnosis and Management of Patients with Renal Colic across a Sample of US Hospitals: High CT Utilization Despite Low Rates of Admission and Inpatient Urologic Intervention. PLoS One 2017; 12:e0169160. [PMID: 28046001 PMCID: PMC5207425 DOI: 10.1371/journal.pone.0169160] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/13/2016] [Indexed: 11/20/2022] Open
Abstract
Objectives Symptomatic ureterolithiasis (renal colic) is a common Emergency Department (ED) complaint. Variation in practice surrounding the diagnosis and management of suspected renal colic could have substantial implications for both quality and cost of care as well as patient radiation burden. Previous literature has suggested that CT scanning has increased with no improvements in outcome, owing at least partially to the spontaneous passage of kidney stones in the majority of patients. Concerns about the rising medical radiation burden in the US necessitate scrutiny of current practices and viable alternatives. Our objective was to use data from a diverse sample of US EDs to examine rates of and variation in the use of CT scanning, admission, and inpatient procedures for patients with renal colic and analyze the influence of patient and hospital factors on the diagnostic testing and treatment patterns for patients with suspected renal colic. Methods We conducted a retrospective cohort study of adult patients who received a diagnosis of renal colic via a visit to an ED at 444 US hospitals participating in the Premier Healthcare Alliance database from 2009–2011. We modeled use of CT, admission, and inpatient urologic intervention as functions of both patient characteristics and hospital characteristics. Results Over the 2-year period, 307,612 patient visits met inclusion criteria. Among these patients, 254,211 (82.6%) had an abdominal CT scan, with 91.5% being non-contrast (“renal protocol”) CT scans. Nineteen percent of visits (58,266) resulted in admission or transfer, and 9.8% of visits (30,239) resulted in a urologic procedure as part of the index visit. On multivariable analysis male patients, Hispanic patients, uninsured patients, and privately insured patients were more likely to have a CT scan performed. Older patients and those covered by Medicare were more likely to be admitted, and once admitted, white patients and privately insured patients were more likely to have a urologic intervention. Only hospital region was associated with variation in CT rates, and this variation was minimal. Region and size of the hospital were associated with admission rates, and hospitals with more practicing urologists had higher intervention rates. Conclusions In this dataset, the majority of patients did not require admission or immediate intervention. Despite this, the large majority received CT scans, in a cohort representing 15–20% of all US ED visits. The CT rate was minimally variable at the hospital level, but the admission rates varied 2-fold, suggesting that hospital-level factors affect patient management. The high rate of CT usage coupled with the low rate of immediate intervention suggests that further research is warranted to identify patients who are at low risk for an immediate intervention, and could potentially be managed with ultrasound alone, expectant management, or delayed CT.
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Abstract
Ureteric colic is a common presentation to acute emergency services. The gold standard test for the diagnosis of acute ureteric colic is a non-contrast computer tomography of the kidneys ureters and bladder (CT KUB). Non-steroidal anti-inflammatory drugs (NSAIDs) should be used as first-line analgesia, with studies showing that there is no role for steroid or phosphodiesterase-5 inhibitors. There is emerging evidence that a high body mass index (BMI) is a risk factor. The drugs used to facilitate stone passage are known as medical expulsive therapy (MET). The most evaluated being alpha-blockers. The Spontaneous Urinary Stone Passage Enabled by Drugs (SUSPEND) trial was designed to evaluate the use of MET (tamsulosin and nifedipine). This trial showed that there was no difference with MET and placebo for the spontaneous passage of ureteric stones. There is an emerging role for the use of primary ureteroscopy in the management of non-infective ureteric stones.
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Imaging of Patients with Renal Colic: A Paradigm Shift. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0156-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hansen KL, Nielsen MB, Ewertsen C. Ultrasonography of the Kidney: A Pictorial Review. Diagnostics (Basel) 2015; 6:diagnostics6010002. [PMID: 26838799 PMCID: PMC4808817 DOI: 10.3390/diagnostics6010002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/12/2015] [Accepted: 12/17/2015] [Indexed: 01/01/2023] Open
Abstract
Ultrasonography of the kidneys is essential in the diagnosis and management of kidney-related diseases. The kidneys are easily examined, and most pathological changes in the kidneys are distinguishable with ultrasound. In this pictorial review, the most common findings in renal ultrasound are highlighted.
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Affiliation(s)
| | - Michael Bachmann Nielsen
- Department of Radiology, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100-DK, Denmark.
| | - Caroline Ewertsen
- Department of Radiology, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100-DK, Denmark.
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