MP54-01 A SYSTEMATIC REVIEW OF CLINICAL SIGNS AND SYMPTOMS, PREDICTION RULES AND IMAGING MODALITIES IN PATIENTS WITH SUSPECTED RENAL COLIC

Abstract

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II (MP54)1 Sep 2021MP54-01 A SYSTEMATIC REVIEW OF CLINICAL SIGNS AND SYMPTOMS, PREDICTION RULES AND IMAGING MODALITIES IN PATIENTS WITH SUSPECTED RENAL COLIC Philipp Dahm, Alex Koziarz, Charles J. Gerardo, Simranjeet Benipal, Daniel K. Nishijima, Jae Hung Jung, and Ali S. Raja Philipp DahmPhilipp Dahm More articles by this author , Alex KoziarzAlex Koziarz More articles by this author , Charles J. GerardoCharles J. Gerardo More articles by this author , Simranjeet BenipalSimranjeet Benipal More articles by this author , Daniel K. NishijimaDaniel K. Nishijima More articles by this author , Jae Hung JungJae Hung Jung More articles by this author , and Ali S. RajaAli S. Raja More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002084.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Suspected renal colic frequently prompts computed tomography (CT) imaging, which is resource-intense, exposes patients to ionizing radiation, and may not always be necessary. We performed this systematic review (SR) and meta-analysis (MTA) to assess the diagnostic accuracy of clinical signs and symptoms, laboratory investigations, prediction rules and imaging modalities commonly used in patients with clinically suspected renal colic. METHODS: We conducted a SR and MTA according to an a priori, registered protocol (PROSPERO CRD42017055153). Literature search was performed across several databases from inception to July 2, 2020. Two independent reviewers performed study screening, selection, quality assessment and data abstraction using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. RESULTS: Among 7641 references screened, 53 were included in the MTA. The overall pooled prevalence for ureteral stones among patients with clinically suspected renal colic was 63% (95% CI: 58-67%). No individual demographic feature, symptom, or sign when present had an LR+≥2.0. The presence of any RBCs on the UA increased the likelihood of a ureteral stone (sensitivity 0.83; specificity 0.59; LR 2.2, 95% CI 1.3-3.6). A score of ≥10 for the Sex, Timing, Origin, Nausea and Erythrocytes (STONE) clinical prediction rule (range: 0–13) had a sensitivity of 0.49; specificity of 0.91; LR+ of 5.3, 95% CI, 4.1-6.7) whereas a score ≥6 had a sensitivity of 0.94, specificity of 0.43; and was able to rule out stones accurately when <6 (LR of 0.15, 95% CI 0.10-0.22). Low dose CT scanning was the most useful imaging technique for identifying patients with or without ureteral stones (sensitivity 0.93; specificity 0.94; LR+ 17, 95% CI, 8.8-31; LR-0.08; 95% CI, 0.03-0.19), ultrasound (sensitivity 0.74; specificity 0.89; LR+ 7.0, 95% CI, 3.4-14; LR- 0.31; 95% CI, 0.16-0.49), and plain x-ray radiographs (sensitivity 0.55; specificity 0.79; LR+ 2.7, 95% CI, 1.9-3.7; LR- 0.57; 95% CI, 0.46-0.68). CONCLUSIONS: Individual signs, symptoms, or the presence of microscopic hematuria do not substantially impact the likelihood of ureteral stones in patients with clinically suspected renal colic. The STONE score may sufficiently guide physicians’ decision to obtain imaging, however further research is required. Low dose non-contrast CT-imaging provides superior diagnostic accuracy compared to all other imaging index tests. Source of Funding: Departmental © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e948-e948 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Philipp Dahm More articles by this author Alex Koziarz More articles by this author Charles J. Gerardo More articles by this author Simranjeet Benipal More articles by this author Daniel K. Nishijima More articles by this author Jae Hung Jung More articles by this author Ali S. Raja More articles by this author Expand All Advertisement Loading ...