MP36-17 NON-CONTRAST COMPUTED TOMOGRAPHY FOR SUSPICION OF OBSTRUCTING UROLITHIASIS IN THE EMERGENCY ROOM: PATTERN AND YIELD

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology I (MP36)1 Apr 2020MP36-17 NON-CONTRAST COMPUTED TOMOGRAPHY FOR SUSPICION OF OBSTRUCTING UROLITHIASIS IN THE EMERGENCY ROOM: PATTERN AND YIELD Ziv Savin*, Snir Dekalo, Eran Schreter, Daniel Trotzky, Sofi Barnes, Galit Aviram, Ofer Yossepowitch, and Mario Sofer Ziv Savin*Ziv Savin* More articles by this author , Snir DekaloSnir Dekalo More articles by this author , Eran SchreterEran Schreter More articles by this author , Daniel TrotzkyDaniel Trotzky More articles by this author , Sofi BarnesSofi Barnes More articles by this author , Galit AviramGalit Aviram More articles by this author , Ofer YossepowitchOfer Yossepowitch More articles by this author , and Mario SoferMario Sofer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000880.017AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Non-contrast computed tomography (NCCT) is the gold reference for diagnosing urolithiasis and became highly available in emergency rooms (ER). We aimed to analyze patterns, yield and clinical implications of assessing suspected obstructive urolithiasis by NCCT in a high volume ER. METHODS: The study comprised 506 consecutive NCCTs performed in ER during one year. Studies were requested by emergency medicine physicians, based on their suspicion, without urological consult. Ureteral stones and/or signs suspected as recent passage of stones (e.g. uretero/hydronephrosis, perinephric edema, stone in bladder, etc.) were considered as validating the suspected diagnosis. Alternate pathologies necessitating hospitalization and clinically significant incidental findings indicating further evaluation were considered situations in which NCCT was warranted. Renal stones without signs of obstruction were considered not related to the acute pain. RESULTS: Ureteral stones confirming the pre-NCCT suspicion were identified in 162 cases (32%). Non-significant nephrolithiasis was detected in 125 patients (25%). In 108 cases (21%) NCCT revealed 167 additional findings but no urolithiasis. The latter group included 42 cases (8%) with 46 clinically significant incidental findings, and 26 cases (5%) with alternate diagnoses requiring hospitalization (Table 1). NCCT was negative in 111 cases (22%). As such, performance of NCCT in the acute setting was overall justified in 230 cases (45%). CONCLUSIONS: It appears that half of the NCCTs performed in ER are not warranted causing an unjustified overload for radiological departments with consequent institutional financial and logistic implications. For these patients, NCCT represents an unnecessary radiation exposure and psychological burden. Further analyses of alternative clinical algorithms are needed in order to reduce NCCT overuse without increasing the risk of significant misdiagnosis in ER. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e529-e529 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ziv Savin* More articles by this author Snir Dekalo More articles by this author Eran Schreter More articles by this author Daniel Trotzky More articles by this author Sofi Barnes More articles by this author Galit Aviram More articles by this author Ofer Yossepowitch More articles by this author Mario Sofer More articles by this author Expand All Advertisement PDF downloadLoading ...