Abstract
BackgroundPoint-of-care ultrasound (PoCUS) by emergency physicians for renal colic has been proposed as an alternative to computed tomography (CT) to avoid ionizing radiation exposure and shorten emergency department length of stay. Previous studies have employed experienced or credentialed ultrasonographers or required advanced ultrasound skills. We sought to measure the diagnostic accuracy of PoCUS by physicians with varied experience using a simplified binary outcome of presence or absence of hydronephrosis. Secondary outcomes include assessment as to whether the presence of hydronephrosis on PoCUS is predictive of complications, and to evaluate possible causes for the reduced diagnostic accuracy such as body mass index (BMI) and time between PoCUS and formal imaging, and scanner experience.Results413 patients were enrolled in the study. PoCUS showed a specificity of 71.8% [95% CI 65.0, 77.9] and sensitivity of 77.1% [95% CI 70.9, 82.6]. Hydronephrosis on PoCUS was predictive of complications (relative risk 3.13; [95% CI 1.30, 7.53]). The time interval between PoCUS and formal imaging, BMI, and scanner experience did not influence the accuracy of PoCUS.ConclusionsPoCUS for hydronephrosis in suspected renal colic has moderate accuracy when performed by providers with varied experience for the binary outcome of presence or absence of hydronephrosis. Hydronephrosis on PoCUS is associated with increased rates of complications. PoCUS for hydronephrosis is limited in its utility as a stand-alone test, however this inexpensive, readily available test may be useful in conjunction with clinical course to determine which patients would benefit from formal imaging or urologic consultation.ClinicalTrials.gov Identifier NCT01323842
Highlights
Point-of-care ultrasound (PoCUS) by emergency physicians for renal colic has been proposed as an alternative to computed tomography (CT) to avoid ionizing radiation exposure and shorten emergency department length of stay
Point-of-care ultrasound (PoCUS) by emergency physicians has been widely adopted in emergency medicine [8] and has been proposed as a cost-effective, quick and radiation-free alternative to CT to aid in decision-making in cases of suspected renal colic [9,10,11,12,13,14,15,16,17]
There was no head-to-head comparison between PoCUS and CT in this comparative effectiveness study, the diagnosis of renal colic was dependent on passage of a stone or surgical intervention rather than formal imaging, and obese patients were excluded from this study, limiting its generalizability [18]
Summary
Radiology ultrasound (radUS) has been proposed as the preferred test for patients at low risk for complications of urolithiasis [6] When using this modality, the calculus is often not visualized and the identification of hydronephrosis due to ureteric obstruction becomes the salient finding. Several studies have reported only moderate sensitivity and specificity of PoCUS for urolithiasis These studies have been performed by either credentialed ultrasonographers [12] or attending emergency physicians [15] or have required physicians to perform complicated scans including grading the degree of hydronephrosis and identifying ureteric jets [10, 11, 14, 17]. There was no head-to-head comparison between PoCUS and CT in this comparative effectiveness study, the diagnosis of renal colic was dependent on passage of a stone or surgical intervention rather than formal imaging, and obese patients were excluded from this study, limiting its generalizability [18]
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