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Taylor M, Woo MY, Pageau P, McInnes MDF, Watterson J, Thompson J, Perry JJ. Ultrasonography for the prediction of urological surgical intervention in patients with renal colic. Emerg Med J 2015; 33:118-23. [PMID: 26177650 DOI: 10.1136/emermed-2014-204524] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 06/22/2015] [Indexed: 11/03/2022]
Abstract
CONTEXT There are no clear indicators of which ultrasound findings in an emergency department (ED) renal colic population are predictive of urological surgical intervention. OBJECTIVE To determine the sonographic findings of renal colic that predict surgical intervention. METHODS We conducted a retrospective cohort study of 500 consecutive ED patients with a diagnosis of renal colic that had ultrasonography (performed by radiology) during their ED visit. Our main outcome was urological surgical intervention. This was defined as extracorporeal shock wave lithotripsy, percutaneous nephrostomy or ureteroscopy performed within 16 weeks of the initial ED presentation. RESULTS Of the 500 identified patients, 483 met our eligibility criteria. Of this group, 67 (13.9%) received a surgical intervention. Ultrasound (US) findings were 97% (95% CI 88.7% to 99.5%) sensitive and 28.1% (23.9% to 32.8%) specific in 'diagnosing' the requirement for surgery when the ultrasound (US) showed either at least a stone present or showed moderate to severe hydronephrosis. The presence of stone and moderate to severe hydronephrosis had a + likelihood ratio (LR) 3.86 (2.46 to 6.07) and a -LR 0.72 (0.60 to 0.86). Having a stone ≥6 mm had a sensitivity of 77.6% (65.5% to 86.5%), a specificity of 73.6% (69.0% to 77.7%), a +LR of 2.94 (2.39 to 3.6) and a -LR 0.30 (0.19 to 0.48). CONCLUSIONS Radiology performed ultrasonography is a valuable tool for identifying renal colic that will go on to receive a surgical intervention in the 16 weeks following an ED visit. Further studies are needed to confirm the utility of ultrasound findings of stone visualisation, stone size and moderate to severe hydronephrosis in determining which patients need outpatient urology follow-up.
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Affiliation(s)
- Mark Taylor
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael Y Woo
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Pageau
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Matthew D F McInnes
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - James Watterson
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada Division of Urology, University of Ottawa, Ottawa, Ontario, Canada
| | - Jesse Thompson
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey J Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Renal Agenesis: A Bedside Sonographic Finding in a Patient with Flank Pain. J Emerg Med 2015; 49:e81-3. [PMID: 26054311 DOI: 10.1016/j.jemermed.2014.12.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/16/2014] [Accepted: 12/22/2014] [Indexed: 11/24/2022]
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Techniques for Minimizing Radiation Exposure During Evaluation, Surgical Treatment, and Follow-up of Urinary Lithiasis. Curr Urol Rep 2015; 16:45. [DOI: 10.1007/s11934-015-0517-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Omar I, Finch W, Wynn M, Winterbottom A, Wiseman OJ. Radiation dosage in the urolithiasis population: Do we over-radiate our patients? JOURNAL OF CLINICAL UROLOGY 2015. [DOI: 10.1177/2051415814567706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: There is increasing concern about the amount of radiation that patients with urolithiasis receive. Ensuring patients are exposed to the minimum necessary radiation is imperative. Here we review the radiation dosages that newly diagnosed urolithiasis patients received in the year following their presentation, both those presenting acutely and those referred electively. Patients and methods: A retrospective study of 95 treatment-naïve patients (47 acute, 48 elective) referred for management of urolithiasis was undertaken. The analysis included all imaging modalities related to stone disease for both patient groups within one year following presentation. The total effective dose (mSV) in one year was calculated by summing the dose for each individual radiation exposure. Results: An average of 5.6 radiological investigations (range 1–14) was carried out for acute patients and 4.57 for elective patients (range 1–11). The mean total effective dose was 14.45 mSV for the acute cases and 12.87 mSV for the elective cases. The maximum radiation dose reached 30.1 mSV in acute patients and 36.51 mSV in elective ones. None of the patients exceeded the maximal annual dose recommended by the International Commission on Radiological Protection (ICRP) of 50 mSV. Conclusion: Management of acute and elective urolithiasis patients can be achieved with acceptable radiation dose exposure. It is extremely important to keep the hazards of radiation in mind whilst managing patients with urolithiasis and clinicians need to remember adherence to the ALARA principle.
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Affiliation(s)
| | | | - Mark Wynn
- Department of Radiology, Cambridge University Hospital, UK
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Penson DF. Re: Ultrasonography versus Computed Tomography for Suspected Nephrolithiasis. J Urol 2015; 193:899. [DOI: 10.1016/j.juro.2014.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hall T, Stephenson J, Rangaraj A, Mulcahy K, Rajesh A. Imaging protocol for suspected ureteric calculi in patients presenting to the emergency department. Clin Radiol 2015; 70:243-7. [DOI: 10.1016/j.crad.2014.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 09/29/2014] [Accepted: 10/22/2014] [Indexed: 10/24/2022]
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Bhatt K, Monga M, Remer EM. Low-dose computed tomography in the evaluation of urolithiasis. J Endourol 2015; 29:504-11. [PMID: 25567006 DOI: 10.1089/end.2014.0711] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Kavita Bhatt
- 1 Imaging Institute, Cleveland Clinic , Cleveland, Ohio
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58
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Deshmukh S, Kambadakone A, Sahani DV, Eisner BH. Hounsfield density of renal papillae in stone formers: analysis based on stone composition. J Urol 2014; 193:1560-3. [PMID: 25444988 DOI: 10.1016/j.juro.2014.10.089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE We examined renal papillary Hounsfield density in stone formers with all common stone subtypes to further understand the pathophysiology of stone formation. MATERIALS AND METHODS Using computerized tomography we measured the Hounsfield density of a 0.2 cm(2) renal papillary area in patients with a single renal calyceal stone. Results were compared with those in patients without a nephrolithiasis history who served as controls. Stone composition was determined by stone passage or extraction during endoscopic procedures using infrared spectroscopy and polarized microscopy. We measured the Hounsfield density of the stone bearing calyx and of a single calyx from the upper, middle and lower poles of each kidney. RESULTS Mean ± SD renal papillary Hounsfield density in controls was 36.2 ± 4.0 HU. In patients with stones Hounsfield density was significantly greater than in controls in stone bearing calyces, nonstone bearing calyces in the affected kidney and calyces in the contralateral nonstone bearing kidney for all stone composition subtypes (range 48.4 to 61.3 HU, each p <0.001). CONCLUSIONS Patients with kidney stones regardless of composition showed the unique radiographic characteristic of increased renal papillary Hounsfield density. This was true for all calyces and for each kidney in all stone formers with a single renal calyceal stone. This radiographic evidence supports the role of renal papillary deposits or plaques in the pathophysiology of stone formation.
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Affiliation(s)
- Sameer Deshmukh
- Departments of Radiology and Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Avinash Kambadakone
- Departments of Radiology and Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dushyant V Sahani
- Departments of Radiology and Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brian H Eisner
- Departments of Radiology and Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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Bechis SK, Eisner BH. The STONE score can help diagnose urolithiasis and decrease the use of CT scans. EVIDENCE-BASED MEDICINE 2014; 19:234. [PMID: 25053641 DOI: 10.1136/ebmed-2014-110017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Seth K Bechis
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brian H Eisner
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Ashurst JV, Cherney AR, Evans EM, Kennedy Hall M, Hess EP, Kline JA, Mitchell AM, Mills AM, Weigner MB, Moore CL. Research priorities for the influence of gender on diagnostic imaging choices in the emergency department setting. Acad Emerg Med 2014; 21:1431-7. [PMID: 25420885 DOI: 10.1111/acem.12537] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 09/05/2014] [Accepted: 09/09/2014] [Indexed: 12/14/2022]
Abstract
Diagnostic imaging is a cornerstone of patient evaluation in the acute care setting, but little effort has been devoted to understanding the appropriate influence of sex and gender on imaging choices. This article provides background on this issue and a description of the working group and consensus findings reached during the diagnostic imaging breakout session at the 2014 Academic Emergency Medicine consensus conference "Gender-specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes." Our goal was to determine research priorities for how sex and gender may (or should) affect imaging choices in the acute care setting. Prior to the conference, the working group identified five areas for discussion regarding the research agenda in sex- and gender-based imaging using literature review and expert consensus. The nominal group technique was used to identify areas for discussion for common presenting complaints to the emergency department where ionizing radiation is often used for diagnosis: suspected pulmonary embolism, suspected kidney stone, lower abdominal pain with a concern for appendicitis, and chest pain concerning for coronary artery disease. The role of sex- and gender-based shared decision-making in diagnostic imaging decisions is also raised.
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Affiliation(s)
- John V. Ashurst
- Department of Emergency Medicine; Lehigh Valley Hospital/USF Morsani College of Medicine; Allentown PA
| | - Alan R. Cherney
- Department of Emergency Medicine; Lehigh Valley Hospital/USF Morsani College of Medicine; Allentown PA
| | - Elizabeth M. Evans
- Department of Emergency Medicine; Lehigh Valley Hospital/USF Morsani College of Medicine; Allentown PA
| | - Michael Kennedy Hall
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
| | - Erik P. Hess
- Department of Emergency Medicine; Mayo Clinic; Rochester MN
| | - Jeffrey A. Kline
- Department of Emergency Medicine; Indiana University School of Medicine; Indianapolis IN
| | - Alice M. Mitchell
- Department of Emergency Medicine; Indiana University School of Medicine; Indianapolis IN
| | - Angela M. Mills
- Department of Emergency Medicine; Perelman School of Medicine; University of Pennsylvania; Philadelphia PA
| | - Michael B. Weigner
- Department of Emergency Medicine; Lehigh Valley Hospital/USF Morsani College of Medicine; Allentown PA
| | - Christopher L. Moore
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
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Moore CL, Daniels B, Ghita M, Gunabushanam G, Luty S, Molinaro AM, Singh D, Gross CP. Accuracy of reduced-dose computed tomography for ureteral stones in emergency department patients. Ann Emerg Med 2014; 65:189-98.e2. [PMID: 25441242 DOI: 10.1016/j.annemergmed.2014.09.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 08/20/2014] [Accepted: 09/05/2014] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE Reduced-dose computed tomography (CT) scans have been recommended for diagnosis of kidney stone but are rarely used in the emergency department (ED) setting. Test characteristics are incompletely characterized, particularly in obese patients. Our primary outcome is to determine the sensitivity and specificity of a reduced-dose CT protocol for symptomatic ureteral stones, particularly those large enough to require intervention, using a protocol stratified by patient size. METHODS This was a prospective, blinded observational study of 201 patients at an academic medical center. Consenting subjects underwent both regular- and reduced-dose CT, stratified into a high and low body mass index (BMI) protocol based on effective abdominal diameter. Reduced-dose CT scans were interpreted by radiologists blinded to regular-dose interpretations. Follow-up for outcome and intervention was performed at 90 days. RESULTS CT scans with both regular and reduced doses were conducted for 201 patients, with 63% receiving the high BMI reduced-dose protocol. Ureteral stone was identified in 102 patients (50.7%) of those receiving regular-dose CT, with a ureteral stone greater than 5 mm identified in 26 subjects (12.9%). Sensitivity of the reduced-dose CT for any ureteral stone was 90.2% (95% confidence interval [CI] 82.3% to 95.0%), with a specificity of 99.0% (95% CI 93.7% to 100.0%). For stones greater than 5 mm, sensitivity was 100% (95% CI 85.0% to 100.0%). Reduced-dose CT identified 96% of patients who required intervention for ureteral stone within 90 days. Mean reduction in size-specific dose estimate was 18.6 milligray (mGy), from 21.7 mGy (SD 9.7) to 3.4 mGy (SD 0.9). CONCLUSION CT with substantial dose reduction was 90.2% (95% CI 82.3% to 95.0%) sensitive and 98.9% (95% CI 85.0% to 100.0%) specific for ureteral stones in ED patients with a wide range of BMIs. Reduced-dose CT was 96.0% (95% CI 80.5% to 99.3%) sensitive for ureteral stones requiring intervention within 90 days.
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Affiliation(s)
- Christopher L Moore
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
| | - Brock Daniels
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Monica Ghita
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT
| | | | - Seth Luty
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Annette M Molinaro
- Departments of Neurosurgery and Epidemiology and Biostatistics, University of San Francisco School of Medicine, San Francisco, CA
| | - Dinesh Singh
- Department of Urology, Yale University School of Medicine, New Haven, CT
| | - Cary P Gross
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
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Moore CL, Bomann S, Daniels B, Luty S, Molinaro A, Singh D, Gross CP. Derivation and validation of a clinical prediction rule for uncomplicated ureteral stone--the STONE score: retrospective and prospective observational cohort studies. BMJ 2014; 348:g2191. [PMID: 24671981 PMCID: PMC3966515 DOI: 10.1136/bmj.g2191] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To derive and validate an objective clinical prediction rule for the presence of uncomplicated ureteral stones in patients eligible for computed tomography (CT). We hypothesized that patients with a high probability of ureteral stones would have a low probability of acutely important alternative findings. DESIGN Retrospective observational derivation cohort; prospective observational validation cohort. SETTING Urban tertiary care emergency department and suburban freestanding community emergency department. PARTICIPANTS Adults undergoing non-contrast CT for suspected uncomplicated kidney stone. The derivation cohort comprised a random selection of patients undergoing CT between April 2005 and November 2010 (1040 patients); the validation cohort included consecutive prospectively enrolled patients from May 2011 to January 2013 (491 patients). MAIN OUTCOME MEASURES In the derivation phase a priori factors potentially related to symptomatic ureteral stone were derived from the medical record blinded to the dictated CT report, which was separately categorized by diagnosis. Multivariate logistic regression was used to determine the top five factors associated with ureteral stone and these were assigned integer points to create a scoring system that was stratified into low, moderate, and high probability of ureteral stone. In the prospective phase this score was observationally derived blinded to CT results and compared with the prevalence of ureteral stone and important alternative causes of symptoms. RESULTS The derivation sample included 1040 records, with five factors found to be most predictive of ureteral stone: male sex, short duration of pain, non-black race, presence of nausea or vomiting, and microscopic hematuria, yielding a score of 0-13 (the STONE score). Prospective validation was performed on 491 participants. In the derivation and validation cohorts ureteral stone was present in, respectively, 8.3% and 9.2% of the low probability (score 0-5) group, 51.6% and 51.3% of the moderate probability (score 6-9) group, and 89.6% and 88.6% of the high probability (score 10-13) group. In the high score group, acutely important alternative findings were present in 0.3% of the derivation cohort and 1.6% of the validation cohort. CONCLUSIONS The STONE score reliably predicts the presence of uncomplicated ureteral stone and lower likelihood of acutely important alternative findings. Incorporation in future investigations may help to limit exposure to radiation and over-utilization of imaging. TRIAL REGISTRATION www.clinicaltrials.gov NCT01352676.
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Affiliation(s)
- Christopher L Moore
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
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Herbst MK, Rosenberg G, Daniels B, Gross CP, Singh D, Molinaro AM, Luty S, Moore CL. Effect of provider experience on clinician-performed ultrasonography for hydronephrosis in patients with suspected renal colic. Ann Emerg Med 2014; 64:269-76. [PMID: 24630203 DOI: 10.1016/j.annemergmed.2014.01.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 12/30/2013] [Accepted: 01/13/2014] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE Hydronephrosis is readily visible on ultrasonography and is a strong predictor of ureteral stones, but ultrasonography is a user-dependent technology and the test characteristics of clinician-performed ultrasonography for hydronephrosis are incompletely characterized, as is the effect of ultrasound fellowship training on predictive accuracy. We seek to determine the test characteristics of ultrasonography for detecting hydronephrosis when performed by clinicians with a wide range of experience under conditions of direct patient care. METHODS This was a prospective study of patients presenting to an academic medical center emergency department with suspected renal colic. Before computed tomography (CT) results, an emergency clinician performed bedside ultrasonography, recording the presence and degree of hydronephrosis. CT data were abstracted from the dictated radiology report by an investigator blinded to the bedside ultrasonographic results. Test characteristics of bedside ultrasonography for hydronephrosis were calculated with the CT scan as the reference standard, with test characteristics compared by clinician experience stratified into 4 levels: attending physicians with emergency ultrasound fellowship training, attending physicians without emergency ultrasound fellowship training, ultrasound experienced non-attending physician clinicians (at least 2 weeks of ultrasound training), and ultrasound inexperienced non-attending physician clinicians (physician assistants, nurse practitioners, off-service rotators, and first-year emergency medicine residents with fewer than 2 weeks of ultrasound training). RESULTS There were 670 interpretable bedside ultrasonographic tests performed by 144 unique clinicians, 80.9% of which were performed by clinicians directly involved in the care of the patient. On CT, 47.5% of all subjects had hydronephrosis and 47.0% had a ureteral stone. Among all clinicians, ultrasonography had a sensitivity of 72.6% (95% confidence interval [CI] 65.4% to 78.9%), specificity of 73.3% (95% CI 66.1% to 79.4%), positive likelihood ratio of 2.72 (95% CI 2.25 to 3.27), and negative likelihood ratio of 0.37 (95% CI 0.31 to 0.44) for hydronephrosis, using hydronephrosis on CT as the criterion standard. Among attending physicians with fellowship training, ultrasonography had sensitivity of 92.7% (95% CI 83.8% to 96.9%), positive likelihood ratio of 4.97 (95% CI 2.90 to 8.51), and negative likelihood ratio of 0.08 (95% CI 0.03 to 0.23). CONCLUSION Overall, ultrasonography performed by emergency clinicians was moderately sensitive and specific for detection of hydronephrosis as seen on CT in patients with suspected renal colic. However, presence or absence of hydronephrosis as determined by emergency physicians with fellowship training in ultrasonography yielded more definitive test results. For clinicians without fellowship training, there was no significant difference between groups in the predictive accuracy of the application according to experience level.
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Affiliation(s)
- Meghan K Herbst
- Department of Emergency Medicine, University of Connecticut, Hartford Hospital, Hartford, CT
| | | | - Brock Daniels
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Cary P Gross
- Department of Medicine, Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Dinesh Singh
- Department of Urology, Yale University School of Medicine, New Haven, CT
| | - Annette M Molinaro
- Department of Neurosurgery, Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA
| | - Seth Luty
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Christopher L Moore
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
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Lim GS, Jang SH, Son JH, Lee JW, Hwang JS, Lim CH, Kim DJ, Cho DS. Comparison of Non-contrast-Enhanced Computed Tomography and Intravenous Pyelogram for Detection of Patients With Urinary Calculi. Korean J Urol 2014; 55:120-3. [PMID: 24578808 PMCID: PMC3935068 DOI: 10.4111/kju.2014.55.2.120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 10/18/2013] [Indexed: 11/25/2022] Open
Abstract
Purpose The aim of this study was to investigate the changing pattern in the use of intravenous pyelogram (IVP), conventional computed tomography (CT), and non-contrast-enhanced computed tomography (NECT) for evaluation of patients with acute flank pain. Materials and Methods We retrospectively reviewed the medical records of 2,180 patients with acute flank pain who had visited Bundang Jesaeng General Hospital between January 2008 and December 2012 and analyzed the use of IVP, conventional CT, and NECT for these patients. Results During the study period there was a significant increase in NECT use (p<0.001) and a significant decrease in IVP use (p<0.001). Conventional CT use was also increased significantly (p=0.001). During this time the proportion of patients with acute flank pain who were diagnosed with urinary calculi did not change significantly (p=0.971). Conclusions There was a great shift in the use of imaging study from IVP to NECT between 2008 and 2012 for patients with acute flank pain.
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Affiliation(s)
- Go San Lim
- Department of Urology, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Seok Heun Jang
- Department of Urology, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Jeong Hwan Son
- Department of Urology, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Jae Won Lee
- Department of Urology, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Jae Seung Hwang
- Department of Urology, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Chae Hong Lim
- Department of Urology, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Dae Ji Kim
- Department of Urology, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Dae Sung Cho
- Department of Urology, Bundang Jesaeng Hospital, Seongnam, Korea
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Ghani KR, Roghmann F, Sammon JD, Trudeau V, Sukumar S, Rahbar H, Kumar R, Karakiewicz PI, Peabody JO, Menon M, Sun M, Trinh QD. Emergency department visits in the United States for upper urinary tract stones: trends in hospitalization and charges. J Urol 2013; 191:90-6. [PMID: 23933053 DOI: 10.1016/j.juro.2013.07.098] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2013] [Indexed: 02/08/2023]
Abstract
PURPOSE Using the Nationwide Emergency Department Sample (NEDS) we examined trends in visits, hospitalization and charges for patients with upper urinary tract stones who presented to the emergency department in the United States. MATERIALS AND METHODS All visits with a primary diagnosis of kidney calculus (ICD-9-CM code 592.0), ureter calculus (592.1) or urinary calculus unspecified (592.9) were extracted from NEDS between 2006 and 2009. A weighted sample was used to calculate incidence rates. Temporal trends were quantified by the estimated annual percent change. Patient and hospital characteristics associated with hospitalization were evaluated using logistic regression models adjusted for clustering. RESULTS Between 2006 and 2009 there were 3,635,054 emergency department visits for upper urinary tract stones. The incidence increased from 289 to 306/100,000 individuals. More men visited than women but women showed significant increases in visits (estimated annual percent change 2.85%, p = 0.018). Total monthly emergency department visits ranged from 5.8% in February to 8.4% in August. Overall 12.0% of patients were hospitalized and the hospitalization rate remained stable (estimated annual percent change -1.02%, p = 0.634). Patients were more likely to be hospitalized if they were female, more ill, seen at an urban teaching or low volume hospital, or had Medicaid or Medicare (each p <0.001). Sepsis was associated with the highest likelihood of hospital admission (OR 69.64, p <0.001). In 2009 charges for emergency department visits increased to $5 billion (estimated annual percent change 10.06%, p = 0.003). CONCLUSIONS Women showed significant annual increases in emergency department visits for upper urinary tract stones. While emergency department charges increased substantially, hospitalization rates remained stable. Greater use of computerized tomography and medical expulsive therapy could be the reasons for this observation, which warrants further study.
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Affiliation(s)
- Khurshid R Ghani
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan.
| | - Florian Roghmann
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Quebec, Canada; Department of Urology, Ruhr University Bochum, Marienhospital, Herne, Germany
| | - Jesse D Sammon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Vincent Trudeau
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Quebec, Canada
| | - Shyam Sukumar
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Haider Rahbar
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Ramesh Kumar
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Quebec, Canada
| | - James O Peabody
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Maxine Sun
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Quebec, Canada
| | - Quoc-Dien Trinh
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan; Division of Urologic Surgery, and Center for Surgery and Public Health, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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Fwu CW, Eggers PW, Kimmel PL, Kusek JW, Kirkali Z. Emergency department visits, use of imaging, and drugs for urolithiasis have increased in the United States. Kidney Int 2013; 83:479-86. [PMID: 23283137 PMCID: PMC3587650 DOI: 10.1038/ki.2012.419] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 09/27/2012] [Accepted: 10/11/2012] [Indexed: 12/17/2022]
Abstract
The occurrence of urolithiasis in the United States has increased; however, information on long-term trends, including recurrence rates, is lacking. Here we describe national trends in rates of emergency department visits, use of imaging, and drug treatment, primarily using the National Hospital Ambulatory Medical Care Survey to describe trends and the National Health and Nutrition Examination Survey to determine the frequency of lifetime passage of kidney stones. Emergency department visit rates for urolithiasis increased from 178 to 340 visits per 100,000 individuals from 1992 to 2009. Increases in visit rates were greater in women, Caucasians, and in those aged 25-44 years. The use of computed tomography in urolithiasis patients more than tripled, from 21 to 71%. Medical expulsive therapy was used in 14% of the patients with a urolithiasis diagnosis in 2007-2009. Among National Health and Nutrition Examination Survey participants who reported a history of kidney stones, 22.4% had passed three or more stones. Hence, emergency department urolithiasis visit rates have increased significantly, as has the use of computed tomography in the United States. Further research is necessary to determine whether recurrent stone formers receive unnecessary radiation exposure during diagnostic evaluation in the emergency department and allow development of corresponding evidence-based guidelines.
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Affiliation(s)
- Chyng-Wen Fwu
- Social & Scientific Systems, Silver Spring, Maryland, USA
| | - Paul W Eggers
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Paul L Kimmel
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - John W Kusek
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Ziya Kirkali
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Terpene compound drug as medical expulsive therapy for ureterolithiasis: a meta-analysis. Urolithiasis 2013; 41:143-51. [DOI: 10.1007/s00240-012-0538-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 12/18/2012] [Indexed: 11/26/2022]
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Fulgham PF, Assimos DG, Pearle MS, Preminger GM. Clinical effectiveness protocols for imaging in the management of ureteral calculous disease: AUA technology assessment. J Urol 2012; 189:1203-13. [PMID: 23085059 DOI: 10.1016/j.juro.2012.10.031] [Citation(s) in RCA: 190] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2012] [Indexed: 11/17/2022]
Abstract
PURPOSE This technology assessment addresses the optimal use of imaging in the evaluation and treatment of patients with suspected or documented ureteral stones. MATERIALS AND METHODS A comprehensive literature search addressing 4 guiding questions was performed for full text in English articles published between January 1990 and July 2011. The search focused on major subtopics associated with the imaging of ureteral calculi, and included specific imaging modalities used in the diagnosis and management of ureteral calculous disease such as unenhanced (noncontrast) computerized tomography, conventional radiography, ultrasound, excretory urography, magnetic resonance imaging and nuclear medicine studies. Protocols (in the form of decision tree algorithms) were developed based on this literature review and in some instances on panel opinion. The 4 questions addressed were 1) What imaging study should be performed for suspected ureteral calculous disease? 2) What information should be obtained? 3) After diagnosis of a ureteral calculus, what followup imaging should be used? 4) After treatment of a ureteral calculus, what followup imaging studies should be obtained? RESULTS Based on these protocols, noncontrast computerized tomography is recommended to establish the diagnosis in most cases, with a low energy protocol advocated if body habitus is favorable. Conventional radiography and ultrasound are endorsed for monitoring the passage of most radiopaque stones as well as for most patients undergoing stone removal. Other studies may be indicated based on imaging findings, and patient, stone and clinical factors. CONCLUSIONS The protocols generated assist the clinician in establishing the diagnosis of ureteral calculous disease, monitoring stone passage and following patients after treatment. The protocols take into account not only clinical effectiveness but also cost-effectiveness and risk/harm associated with the various imaging modalities.
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Affiliation(s)
- Pat Fox Fulgham
- Texas Health Presbyterian Hospital of Dallas, Dallas, Texas 75231, USA.
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Affiliation(s)
- Margaret S Pearle
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA.
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