Abstract
IntroductionSupporting an “ultrasound-first” approach to evaluating renal colic in the emergency department (ED) remains important for improving patient care and decreasing healthcare costs. Our primary objective was to compare emergency physician (EP) ultrasound to computed tomography (CT) detection of hydronephrosis severity in patients with suspected renal colic. We calculated test characteristics of hydronephrosis on EP-performed ultrasound for detecting ureteral stones or ureteral stone size >5mm. We then analyzed the association of hydronephrosis on EP-performed ultrasound, stone size >5mm, and proximal stone location with 30-day events.MethodsThis was a prospective observational study of ED patients with suspected renal colic undergoing CT. Subjects had an EP-performed ultrasound evaluating for the severity of hydronephrosis. A chart review and follow-up phone call was performed.ResultsWe enrolled 302 subjects who had an EP-performed ultrasound. CT and EP ultrasound results were comparable in detecting severity of hydronephrosis (x2=51.7, p<0.001). Hydronephrosis on EP-performed ultrasound was predictive of a ureteral stone on CT (PPV 88%; LR+ 2.91), but lack of hydronephrosis did not rule it out (NPV 65%). Lack of hydronephrosis on EP-performed ultrasound makes larger stone size >5mm less likely (NPV 89%; LR− 0.39). Larger stone size > 5mm was associated with 30-day events (OR 2.30, p=0.03).ConclusionUsing an ultrasound-first approach to detect hydronephrosis may help physicians identify patients with renal colic. The lack of hydronephrosis on ultrasound makes the presence of a larger ureteral stone less likely. Stone size >5mm may be a useful predictor of 30-day events.
Highlights
Supporting an “ultrasound-first” approach to evaluating renal colic in the emergency department (ED) remains important for improving patient care and decreasing healthcare costs
emergency physician (EP)-performed ultrasound can identify the severity of hydronephrosis in patients with suspected renal colic compared to computed tomography (CT)
The diagnostic test characteristics of hydronephrosis detected by EP-performed US indicates that any degree of hydronephrosis is a good predictor for the presence of a ureteral stone on CT, but may be less reliable in identifying larger stones than previously reported in the literature
Summary
As many as 50% of patients diagnosed with renal colic will have recurrent episodes and may receive multiple CTs throughout their lifetime, adding to costs, increased length of stay, and radiation exposure.[10,11,12,13] There are currently no validated practice guidelines for the diagnosis and ED management of renal colic; the need for a multidisciplinary approach to managing this disease is clear.[12,14,15,16,17].The role of emergency physician(EP) performed ultrasound (US) in the management of patients with renal colic has recently gained more attention, but its incorporation into an accepted algorithm remains debatable.[18,19,20,21]
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