Colic Patients Research Articles

Ureteral Stent Insertion in the Management of Renal Colic during Pregnancy.

To determine an optimal invasive intervention for renal colic patients during pregnancy after conservative treatments have been found to be unhelpful. Among the available invasive interventions, we investigated the reliability of a ureteral stent insertion, which is considered the least invasive intervention during pregnancy. Between June 2006 and February 2015, a total of 826 pregnant patients came to the emergency room or urology outpatient department, and 39 of these patients had renal colic. The mean patient age was 30.49 years. In this retrospective cohort study, the charts of the patients were reviewed to collect data that included age, symptoms, the lateralities and locations of urolithiasis, trimester, pain following treatment and pregnancy complications. Based on ultrasonography diagnoses, 13 patients had urolithiasis, and 13 patients had hydronephrosis without definite echogenicity of the ureteral calculi. Conservative treatments were successful in 25 patients. Among these treatments, antibiotics were used in 15 patients, and the remaining patients received only hydration and analgesics without antibiotics. Several urological interventions were required in 14 patients. The most common intervention was ureteral stent insertion, which was performed in 13 patients to treat hydronephrosis or urolithiasis. The patients' pain was relieved following these interventions. Only one patient received percutaneous nephrostomy due to pyonephrosis. No pregnancy complications were noted. Ureteral stent insertion is regarded as a reliable and stable first-line urological intervention for pregnant patients with renal colic following conservative treatments. Ureteral stent insertion has been found to be equally effective and safe as percutaneous nephrostomy, which is associated with complications that include bleeding and dislocation, and the inconvenience of using external drainage system.

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We thank for these pleasant comments and are happy that the idea of dose-reduced computed tomography (CT) and CT-based compositional analysis of urinary stones is of importance for the editors of Urology. 1 Slater R.C. Jackman S.V. Focused dual-energy CT maintains diagnostic and compositional accuracy for urolithiasis using ultralow-dose noncontrast CT [Editorial Comment]. Urology. 2015; 86: 1097-1103 Abstract Full Text Full Text PDF PubMed Google Scholar New developments of imaging modalities have influenced different fields of medicine sustainably, including urolithiasis management. In many urology departments, CT has replaced radiography of kidney, ureter, and bladder as well as intravenous pyelogram almost completely in primary evaluation of renal colic patients. Over the years, the CT technology could be improved significantly due to bringing innovations such as dose-reduced protocols, shorter examination times, high-definition imaging, and in situ compositional analysis of the targeted stones. Our study was performed on 61 patients revealing high sensitivity and specificity in detection of clinically relevant uric acid- and non–uric acid-containing fragments. 1.We believe that similar results for sensitivity and specificity rates can be reproduced in other institutions using the highly dose-reduced noncontrast CT (NCCT) protocol including compositional analysis. The methods applied have been described in detail. We would be very pleased if other groups, wishing to decrease radiation exposure of urolithiasis patients, would join our efforts and work on related topics in collaborative projects. 2.In the German health care system, the radiologist is involved in the evaluation process of the CT results and decision making whether the dual-energy (DE) technology is applied. Because of this organization model, a significant decrease in radiation can be achieved. We are aware that this is not the case in many countries worldwide. As a consequence, this might be the crucial limitation in the acceptance of this approach in differently organized health care systems, where CT scans are not interpreted directly by a radiologist and the image acquisition is performed independently by excellently trained radiology technicians. We believe that diagnosing urolithiasis might be feasible for such personnel after professional training. Furthermore, these measures would make radiology technicians more familiar with the DE technology and novel CT protocols. In our opinion, the decision whether to use a targeted DE mode scan can also be taken by a radiology technician. In countries where legal issues prohibit such course of action, efforts should be undertaken to rearrange the workflow in radiology departments and establish a timely involvement of a radiologist in the CT scan evaluation in stone patients. 3.Conventional NCCT might provide reliable information regarding stone composition based on Hounsfield unit characteristics of a visualized fragment. However, this might not be accurate in many cases and leads to substantially higher patient radiation exposure. To our knowledge, it is not possible to determine the stone composition correctly while performing an NCCT according to an ultralow energy dose protocol. Therefore, an additional DE technology–based analysis has to be implemented. Applying our novel protocol, low-dose NCCT plus DE mode–based analysis of stone composition results in significantly lower cumulative radiation exposure and provides superior results at the same time. “Primum non nocere” (first, do no harm): We believe that this justifies potentially higher financial expenses and time. Editorial CommentUrologyVol. 86Issue 6PreviewThe authors provide a timely demonstration of an innovative low-dose noncontrast computed tomography (NCCT) plus dual-energy CT (DECT) protocol in reducing radiation exposure in the evaluation of patients presenting with urolithiasis while simultaneously maintaining accurate compositional analysis of such calculi.1 This protocol calls for patients to undergo an ultralow-dose NCCT followed by a focused dose-reduced noncontrast DECT. It was evaluated in 61 patients whose stones were available for chemical analysis. Full-Text PDF

Desmopressin as an adjuvant to opioids or NSAIDs in treatment of renal colic: a nationwide register-based study.

Desmopressin has been reported to be effective as an adjuvant to opioids or NSAIDs in management of pain in renal colic; however real-life data are lacking on the utilisation of desmopressin in this patient segment. The Danish National Prescription Registry data-linked with Danish National Patient Registry during a 3-year period from 2009 to 2011 was used to study prescriptions for desmopressin in renal colic. We identified 888 desmopressin prescriptions for renal colic, dispensed to 95 patients. The mean treatment period was 159 days, with a large variation up to a maximum of 924 days. Approximately two thirds of patients received dosing instructions to administer the drug 4 times daily to provide 24-h antidiuretic coverage. Among concomitant opioids and NSAIDs, tramadol and ibuprofen were prescribed most frequently. Antidepressants and diuretics were also widely used. A clear sex difference was seen, with female renal colic patients having three times more prescriptions overall than males, and in particular receiving more antidepressants and psychotropic drugs. A total of 4 (4.2%) of the patients experienced hospital admissions because of hyponatraemia or polydipsia during the 3-year period. We confirmed a previous case report that nephrolithiasis could be at least an occasional complication of successful therapy of Central Diabetes Insipidus (CDI) with desmopressin, identifying 12 CDI patients in total, or 2.4% of all Danish CDI patients in that period, who were also treated for renal colic. In summary, these real-life prescription data provide exact epidemiological measures on desmopressin utilisation in renal colic.

Monitoring acute equine visceral pain with the Equine Utrecht University Scale for Composite Pain Assessment (EQUUS-COMPASS) and the Equine Utrecht University Scale for Facial Assessment of Pain (EQUUS-FAP): A scale-construction study

Although recognition of equine pain has been studied extensively over the past decades there is still need for improvement in objective identification of pain in horses with acute colic. This study describes scale construction and clinical applicability of the Equine Utrecht University Scale for Composite Pain Assessment (EQUUS-COMPASS) and the Equine Utrecht University Scale for Facial Assessment of Pain (EQUUS-FAP) in horses with acute colic. A cohort follow-up study was performed using 50 adult horses (n = 25 with acute colic, n = 25 controls). Composite pain scores were assessed by direct observations, Visual Analog Scale (VAS) scores were assessed from video clips. Colic patients were assessed at arrival, and on the first and second mornings after arrival. Both the EQUUS-COMPASS and EQUUS-FAP scores showed high inter-observer reliability (ICC = 0.98 for EQUUS-COMPASS, ICC = 0.93 for EQUUS-FAP, P < 0.001), while a moderate inter-observer reliability for the VAS scores was found (ICC = 0.63, P < 0.001). The cut-off value for differentiation between healthy and colic horses for the EQUUS-COMPASS was 5, and for differentiation between conservatively treated and surgically treated or euthanased patients it was 11. For the EQUUS-FAP, cut-off values were 4 and 6, respectively.Internal sensitivity and specificity were good for both EQUUS-COMPASS (sensitivity 95.8%, specificity 84.0%) and EQUUS-FAP (sensitivity 87.5%, specificity 88.0%). The use of the EQUUS-COMPASS and EQUUS-FAP enabled repeated and objective scoring of pain in horses with acute colic. A follow-up study with new patients and control animals will be performed to further validate the constructed scales that are described in this study.

NORMAL ED ULTRASOUND PREDICTS LOW RISK RENAL COLIC PATIENTS FOR UROLOGICAL INTERVENTION WITHIN 90 DAYS

Background: CT scan has emerged to be the investigation of choice for renal colic patients in the emergency setting. Ultrasound (US) provides an alternative modality with minimal radiation risk. &#x0D; Objective: The purpose of this study is to determine the ability of US to identify renal colic patients who are at low risk for urological interventions within 90 days of their initial ED visit. &#x0D; Methods: A retrospective cross sectional observational chart review study was conducted in a tertiary care hospital, Royal Hospital, Oman from Jan2009 to Feb2013 using the electronic medical records to extract the data by Trained abstractors. &#x0D; Results: 302 patients were enrolled in the study. 92 (30 %) had normal US results while 210 (70 %) had abnormal US. Only 1.3 % of those with normal US results had CT in comparison to 13% with abnormal US. There were 51 (16%) patients who underwent urosurgical intervention within 90 days of ED visit. 1.7% from the normal ultrasound group whereas 15% from the abnormal ultrasound group P.value 0.001 &#x0D; Conclusion: A normal US results in low risk renal colic patient may predict low likelihood for urological intervention within 90 days from ED presentation. &#x0D; Word count: 192

The effect of meteorological parameters on the number of renal colic patients.

In this study, we investigated the effect of meteorological parameters on the number of renal colic patients who admitted to the emergency department regarding patients' gender, patients' age and season. Patients who were admitted to the emergency department with renal colic during a year were studied retrospectively. The number of patients admitted daily was divided into groups according to gender, age and seasons, and correlations between the daily meteorological parameters were examined. In our study, a total of 1890 patients were enrolled and of those 64.9% (n=1227) were male. The mean age of the patients was 38±14.7/years (18-94). The number of patients admitted daily was 5±2.9/patients (1-18). Positive correlation was found between the daily number of patients and daily maximum temperature (p<0.001, r=0.212), and daily minimum temperature (p=0.003, r=0.160) and daily temperature difference (p<0.001, r=0.218). Additionally, a negative correlation with the daily relative humidity (p=0.001, r=-0.169) was detected. As a result of multivariate regression analysis, age was found to independently affect the number of RC patients admitted to the emergency department (R2 0.0079, t -3.56, p<0.001). Negative correlation was found between relative humidity and female patients, patients in the 30-39 years of age group, and the daily number of RC patients admitted in spring. We found positive correlation between temperature and the number of patients under the age of 39 years, but we concluded that the daily number of patients above the age of 40 years did not significantly correlate with temperature rise. In our study, we determined that meteorological parameters have an effect on renal colic and that this effect varies depending on the patients' age, patients' gender and season.

Failed validation of risk prediction model for intervention in renal colic patients after emergency department evaluation.

It has been reported that three criteria (size of calculus ≥6 mm, visual analogue scale pain score at discharge ≥2 cm and location above mid-ureter; the Papa criteria) were sensitive for predicting patients who require intervention (surgery or lithotripsy) within 28 days of index emergency department (ED) visit for ureteric colic. It was suggested that absence of these criteria identified a group for whom early follow-up may not be needed. No validation has been reported. We aimed to validate these criteria. Retrospective cohort study of patients with clinical presentation of ureteric colic and radiologically proven renal tract stones. Data collected included demographics, clinical features, features of the stone, imaging results and 28-day outcome. Outcome of interest was performance of the Papa criteria for prediction of urological intervention by clinical performance analysis. We also undertook a post hoc analysis to identify predictors of urological intervention for the group overall and for the subgroup discharged from ED. Two hundred and twenty-four patients were studied (median age 49, 79% male) with 75 (33%) requiring urological intervention within 28 days. The presence of any of the Papa criteria had sensitivity for urological intervention of 83.9% (95% confidence interval (CI) 71.2-91.9%) with specificity of 47.7% (95% CI 38.9-56.6%), positive predictive value of 40.9% (95% CI 31.9-50.4%) and negative predictive value of 87.3% (95% CI 76.8-93.7%). Nine patients with no Papa criteria had intervention: 12.7% (95% CI 6.8-22.4%). The Papa criteria are not sufficiently accurate to determine which patients require intervention or a subgroup who do not need specialist urological follow-up.

Clinical Efficacy of Metoclopramide to Treat Pain and Nausea in Renal Colic Patients: A Prospective Randomised, Double-Blind, Controlled Trial

Introduction This study aimed to evaluate the clinical efficacy of intravenous metoclopramide for the relief of pain and nausea among the emergency department patients with renal colic. Methods Patients were randomised into three groups: tenoxicam (20 mg); tenoxicam (10 mg) plus metoclopramide (10 mg); and metoclopramide (10 mg). Changes in pain and nausea were examined at the 10th, 20th and 30th minute after treatment. The development of side effects would be recorded. After the 30th minute, the need for additional pain and nausea relief was evaluated. Results Totally 80 patients were enrolled in each group. There was significant mean pain score difference as measured by visual analog scale (VAS) from 0 minute to 10th, 20th and 30th minute post-treatment for all treatment groups (p&lt;0.001). There was no significant difference in mean VAS decrease from 0 minute to the 30th minute: tenoxicam group: 36 mm [95% confidence interval (CI) 28-43 mm] vs. tenoxicam plus metoclopramide: 45 mm (95% CI 38-52 mm) vs. metoclopramide group: 37 mm (95% CI 30-45 mm) (p=0.163). Similarly, no significant differences in mean nausea scores between the three groups were demonstrated at the 10th, 20th and 30th minute after treatment (p=0.236, 0.330 and 0.652 respectively). After the 30th minute, 43 (53%) patients needed additional pain relieving agent in the tenoxicam group compared to 27 (33%) patients in the tenoxicam-metoclopramide group and 33 (41%) patients in the metoclopramide group (p=0.030). No significant adverse drug reaction events were encountered. Conclusion Metoclopramide is as effective as tenoxicam to treat pain and nausea for patients with renal colic in the emergency department. (Hong Kong j.emerg.med.2015;22:93-99)

Comparison of the efficacy of diclofenac, acupuncture, and acetaminophen in the treatment of renal colic

ObjectiveThe objective is to compare the analgesic effects of diclofenac, acetaminophen, and acupuncture in urolithiasis-driven renal colic pain relief. MethodsRenal colic patients were divided randomly into 3 groups. Patients in group I (n = 40) were treated with intravenous acetaminophen, those in group II (n = 41) with acupuncture, and those in group III (n = 40) with a 75-mg intramuscular injection diclofenac sodium. Visual analogue scale (VAS) and verbal rating scale (VRS) were used to assess pain intensity after 10, 30, 60, and 120 minutes. ResultsNo significant differences in baseline VAS or VRS were found with regard to age or sex. After 10 minutes, all 3 groups experienced a significant decrease in VAS and VRS scores, with the most drastic decrease occurring in group II. After 30 minutes, there was a significantly higher decrease in group III than in group I (P = .001). After 60 minutes, mean VAS scores of groups I and III (P = .753) were similar. The mean VAS score of group III was lower than that of group II (P = .013). After 120 minutes, the difference in the VAS scores was (P = .000) between groups I and II and between groups II and III. Yet, the VAS evaluation made after 120 minutes revealed statistically similar outcomes for groups I and III (P = .488). The statistical findings for VRS evaluations made after 10, 30, 60, and 120 were similar to those for VAS. ConclusionsIn renal colic patients with a possible nonsteroidal anti-inflammatory drug and acetaminophen side effect risk, acupuncture emerges as an alternative treatment modality.

Normal renal sonogram identifies renal colic patients at low risk for urologic intervention: a prospective cohort study.

Determining which patients with ureterolithiasis are likely to require urologic intervention is a common challenge in the emergency department (ED). The objective was to determine if normal renal sonogram could identify low-risk renal colic patients, who were defined as not requiring urologic intervention within 90 days of their initial ED visit and can be managed conservatively. This was a prospective cohort study involving adult patients presenting to the EDs of a tertiary care centre with suspected renal colic over a 20-month period. Renal ultrasonography (US) was performed in the diagnostic imaging department by trained ultrasonographers, and the results were categorized into four mutually exclusive groups: normal, suggestive of ureterolithiasis, visualized ureteric stone, or findings unrelated to urolithiasis. Electronic medical records were reviewed to determine if patients received urologic intervention within 90 days of their ED visit. Of 610 patients enrolled, 341 (55.9%) had US for suspected renal colic. Of those, 105 (30.8%) were classified as normal; none of these patients underwent urologic intervention within 90 days of their ED visit. Ninety (26.4%) US results were classified as suggestive, and nine (10%) patients received urologic intervention. A total of 139 (40.8%) US results were classified as visualized ureteric stone, and 34 (24.5%) patients had urologic intervention. Seven (2.1%) US results were classified as findings unrelated to urolithiasis, and none of these patients required urologic intervention. The rate of urologic intervention was significantly lower in those with normal US results (p<0.001) than in those with abnormal findings. A normal renal sonogram predicts a low likelihood for urologic intervention within 90 days for adult ED patients with suspected renal colic.

Comparison of the Therapeutic Effects of Rectal Diclofenac Sodium and Intramuscular Pethidine Injection in the Treatment of Acute Renal Colic: A Randomized Clinical Trail

Objectives: Renal colic is a type of abdominal pain commonly caused by obstructive stones. The aim of this study was to compare the safety and efficacy of rectal diclofenac sodium (RDS) and intramuscular pethidine (IMP) injection in acute renal colic. Materials and Methods: In an interventional prospective double-blind randomized clinical trial, 541 patients who had referred to our center because of acute renal colic were divided into two groups: (1) RDS with 266 participants and (2) IMP with 275 participants. Pain relief was measured by asking the participants at 10, 20 and 30 minutes after taking each drug. Results: In RDS group, analgesic effects of RDS were apparent in 121 participants (45.5%) after 10 min, in 191 participants (71.9%) after 20 min and in 233 participants (87.5%) after 30 min. 33 participants (12.5%) had no response to RDS. In IMP group, analgesic effects of IMP were apparent in 123 participants (44.7%) after 10 min, in 191 participants (69.5%) after 20 min and in 254 participants (92.3%) after 30 min. 21 participants (7.7%) had no response to IMP. Statistical analysis revealed that there was no significant difference between the two studied drugs in relieving renal colic pain (P=0.06). Conclusion: Although there was no significant difference in analgesic effect between the two drugs, using diclofenac sodium in suppository form is highly recommended for renal colic patients because of availability, being less expensive, safety, and its self-administration.

Value of color doppler ultrasound, kub and urinalysis in diagnosis of renal colic due to ureteral stones

Purpose Despite the routine use of helical CT in diagnosis of renal colic, there are recent concerns regarding the radiation exposure, overuse and costs. We attempted in this retrospective study to evaluate the accuracy of ultrasound (gray-scale and color Doppler with twinkling), KUB and urinalysis in diagnosis of renal colic due to ureteral calculi presented in Emergency Room. Materials and Methods A total of 939 consecutive cases of renal colic presented to ER have been managed and evaluated by ureteral ultrasound, KUB and urinalysis for the presence of ureteral stones. Non-confirmatory cases were subjected to Helical CT examination. Results Renal and ureteral ultrasound (gray-scale) alone detected ureteral calculi in 615 cases (65.4%) and after utilizing Color Doppler Ultrasound with twinkling the diagnosis was made with confidence in 935 cases (99.6%) but 4 (0.4%). KUB showed radiopaque stones in 503 (53.6%) patients and no stones were detected in 436 (46.4%). Microhematuria presented in 835 (88.9%) cases while absent in 102 (10.9%). There were 190 (20.3%), 77 (8.2%) and 671 (71.5%) patients with upper, middle and lower ureteral stones respectively. The simultaneous positive findings in US and KUB with microhematuria were found only in 453 (48.2%) cases. Conclusions The use of Color Doppler ultrasound with twinkling increased the detection rate of ureteral stones in acute renal colic patients presented to ER with less radiation exposure. Ultrasound examination as a single modality is superior to KUB and urinalysis in initial diagnosis of renal colic.

Nonintravenous Therapy for Acute Renal Colic Pain

Emergency clinicians commonly administer intravenous opioids to relieve pain in renal colic patients. But would a sublingual analgesic be as effective?

Su1654 Botulinum Toxin Injection As a Predictive Tool in the Diagnostic and Therapeutic Approach for Sphincter of Oddi Dysfunction Type III in Pediatrics

Su1654 Botulinum Toxin Injection As a Predictive Tool in the Diagnostic and Therapeutic Approach for Sphincter of Oddi Dysfunction Type III in Pediatrics

Su1655 Attitudes and Practices Regarding Type II Sphincter of Oddi Dysfunction (SOD): a Comparative Survey Study of Expert Biliary Endoscopists and Referring Gastroenterologists

Su1655 Attitudes and Practices Regarding Type II Sphincter of Oddi Dysfunction (SOD): a Comparative Survey Study of Expert Biliary Endoscopists and Referring Gastroenterologists

Value of Color Doppler ultrasound, kub and urinalysis in diagnosis of renal colic due to ureteral stones.

Despite the routine use of helical CT in diagnosis of renal colic, there are recent concerns regarding the radiation exposure, overuse and costs. We attempted in this retrospective study to evaluate the accuracy of ultrasound (gray-scale and color Doppler with twinkling), KUB and urinalysis in diagnosis of renal colic due to ureteral calculi presented in Emergency Room. A total of 939 consecutive cases of renal colic presented to ER have been managed and evaluated by ureteral ultrasound, KUB and urinalysis for the presence of ureteral stones. Non-confirmatory cases were subjected to Helical CT examination. Renal and ureteral ultrasound (gray-scale) alone detected ureteral calculi in 615 cases (65.4%) and after utilizing Color Doppler Ultrasound with twinkling the diagnosis was made with confidence in 935 cases (99.6%) but 4 (0.4%). KUB showed radiopaque stones in 503 (53.6%) patients and no stones were detected in 436 (46.4%). Microhematuria presented in 835 (88.9%) cases while absent in 102 (10.9%). There were 190 (20.3%), 77 (8.2%) and 671 (71.5%) patients with upper, middle and lower ureteral stones respectively. The simultaneous positive findings in US and KUB with microhematuria were found only in 453 (48.2%) cases. The use of Color Doppler ultrasound with twinkling increased the detection rate of ureteral stones in acute renal colic patients presented to ER with less radiation exposure. Ultrasound examination as a single modality is superior to KUB and urinalysis in initial diagnosis of renal colic.

Comparison of clinical efficacy of intravenous acetaminophen with intravenous morphine in acute renal colic: a randomized, double-blind, controlled trial.

The aim of this study was to compare the clinical efficacy of intravenous acetaminophen with intravenous morphine in acute renal colic pain management. In this double-blind controlled trial, patients aged 18–55 years, diagnosed with acute renal colic, who met the inclusion and exclusion criteria, were randomized into two groups. First, using the visual analogue scale (VAS), intensity of pain was assessed in both groups. Then, one gram of intravenous acetaminophen or 0.1 mg/kg morphine was infused in 100 mL normal saline to either acetaminophen or morphine group. Intensity of pain was reassessed in 15, 30, 45, and 60 minutes according to VAS criteria. Finally, data from 108 patients were analyzed, 54 patients in each group. No significant difference was observed between the two groups in regard to sex (P = 0.13), mean age (P = 0.54), and baseline visual analogue score (P = 0.21). A repeated measure analysis of variance revealed that the difference between the two treatments was significant (P = 0.0001). The VAS reduction at primary endpoint (30 min after drug administration) was significantly higher in the acetaminophen group than in the morphine group (P = 0.0001). This study demonstrated that intravenous acetaminophen could be more effective than intravenous morphine in acute renal colic patients' pain relief.

The Comparison of the Relationship between Haematuria Severity and Analgesia in Renal Colic Patients

Objective: Patients with Renal colic attack are usually admitted to hospital due to single-sided, sharp and sudden localised pain. 90% of patients have haematuria. Some analgesics might be used alone or in combination. This study was conducted to establish the relationship between haematuria severity determined in renal colic patients admitted to the ED and the efficacy of intramuscular (IM) non-steroid analgesic application. Material and Methods: The study was carried out prospectively in the Emergency Department. A total of 87 out of the possible 106 patients were included in the study. Pain severity was measured in accordance with the “Visual Analogue Scale” (VAS). Urine samples from patients were first evaluated mac roscopically and then microscopically after being centrifuged to determine Erythrocyte count/hpf (high power field). VAS pain severity of patients who received 75 mg/3 mL Diclofenac sodium IM as an analgesic was measured and recorded at the time of admission; the measurements were repeated 20, 30 and 45 minutes after the analgesic was given. Results: When the score differences were examined between VAS values at the time of admission of patients and at 20, 30, and 45 mins after analgesia, a significantly positive correlation was found between haematuria severity and analgesic efficacy (p=0.003, r=0.311). Conclusion: If there is intensive or red colour anamnesis in patients presenting to the ED who are likely to be diagnosed as renal colic, the initial application of IM non-steroid analgesic may provide better pain palliation and increase patient comfort. (JAEM 2013; 12: 195-8)

Multicenter Analysis of Factors Associated With Delayed Analgesia and Response to Pain Medication in Pediatric Renal Colic Patients

Multicenter Analysis of Factors Associated With Delayed Analgesia and Response to Pain Medication in Pediatric Renal Colic Patients

Custos hospitalares do diagnóstico e tratamento da cólica renal em um serviço de emergência privado brasileiro

JUSTIFICATIVA E OBJETIVOS: A incidência de cólica renal tem aumentado nos países em desenvolvimento por diversos fatores e leva o indivíduo ao serviço de emergência em função da necessidade de alívio da dor aguda e intensa que esta provoca. O impacto econômico do diagnóstico e tratamento em caráter emergencial é desconhecido em nosso meio. O objetivo deste estudo foi avaliar o custo do diagnóstico e tratamento da cólica renal em serviço de emergência privado e as variáveis que influenciam neste custo. MÉTODO: Trata-se de um estudo retrospectivo em que foram analisados os prontuários de pacientes atendidos com cólica renal entre agosto e setembro de 2010 em um serviço de emergência privado de São Paulo. RESULTADOS: Foram avaliados 136 prontuários de pacientes de ambos os sexos, com idade média de 39 anos, 52% com antecedente de cálculo e 30% com outras comorbidades. A escada analgésica da Organização Mundial da Saúde (OMS) foi utilizada em 48% dos casos. O custo total foi em média R$453,62 e a influência do tempo de permanência do paciente no custo foi significante. CONCLUSÃO: O custo foi bastante variado, tendo em vista o estudo ter sido realizado em uma instituição privada, com fontes pagadoras diversas. O tempo de permanência do paciente no serviço de emergência foi a única variável com significância estatística em relação ao aumento dos custos. Estratégias eficazes de tratamento e qualidade assistencial, que reduzam o tempo de permanência do paciente no serviço de emergência poderão refletir na redução dos custos do atendimento.