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Elsayed Y, Soylu H. Point-of-care abdominal ultrasound in pediatric and neonatal intensive care units. Eur J Pediatr 2024; 183:2059-2069. [PMID: 38459132 DOI: 10.1007/s00431-024-05443-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 03/10/2024]
Abstract
A spectrum of critical abdominal pathological conditions that might occur in neonates and children warrants real-time point-of-care abdominal ultrasound (abdominal POCUS) assessment. Abdominal radiographs have limited value with low sensitivity and specificity in many cases and have no value in assessing abdominal organ perfusion and microcirculation (Rehan et al. in Clin Pediatr (Phila) 38(11):637-643, 1999). The advantages of abdominal POCUS include that it is non-invasive, easily available, can provide information in real-time, and can guide therapeutic intervention (such as paracentesis and urinary bladder catheterization), making it a crucial tool for use in pediatric and neonatal abdominal emergencies (Martínez Biarge et al. in J Perinat Med 32(2):190-194, 2004) and (Alexander et al. in Arch Dis Child Fetal Neonatal Ed 106(1):F96-103, 2021). Conclusion: Abdominal POCUS is a dynamic assessment with many ultrasound markers of gut injury by two dimensions (2-D) and color Doppler (CD) compared to the abdominal X-ray; the current evidence supports the superiority of abdominal POCUS over an abdominal X-ray in emergency situations. However, it should still be considered an adjunct rather than replacing abdominal X-rays due to its limitations and operator constraints (Alexander et al. in Arch Dis Child Fetal Neonatal Ed 106(1):F96-103, 2021). What is Known: • Ultrasound is an important modality for the assessment of abdominal pathologies. What is New: • The evidence supports the superiority of abdominal POCUS over an abdominal X-ray in emergency abdominal situations in the neonatal and pediatric intensive care units.
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Affiliation(s)
- Yasser Elsayed
- Section of Neonatology, Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada.
- Women's Hospital, 820 Sherbrook Street, Winnipeg, MB, R2016, R3A0L8, Canada.
| | - Hanifi Soylu
- Section of Neonatology, Department of Pediatrics, Selcuk University, Konya, Turkey
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2
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Gaudreau-Simard M, Saiyin T, Mcinnes MDF, Ruller S, Clark EG, Wooller K, Kilabuk E, Forster AJ, Woo MY. Test characteristics of point-of-care ultrasonography in patients with acute kidney injury. Ultrasound J 2024; 16:15. [PMID: 38388747 PMCID: PMC10884383 DOI: 10.1186/s13089-023-00352-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/13/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Acute kidney injury is a common disorder that is associated with significant morbidity and mortality. Point-of-care ultrasonography (PoCUS) is an imaging modality performed at the bedside and is used to assess for obstructive causes of acute kidney injury. Little is known about the test characteristics of PoCUS in patients with acute kidney injury. OBJECTIVE Our primary objective was to describe the test characteristics of PoCUS for the detection of hydronephrosis in patients presenting with acute kidney injury at our centre. Our secondary objective was to describe the current rate of use of PoCUS for this indication. RESULTS In total, 7873 patients were identified between June 1, 2019 and April 30, 2021, with 4611 meeting inclusion criteria. Of these, 94 patients (2%) underwent PoCUS, and 65 patients underwent both PoCUS and reference standard, for a total of 124 kidneys included in our diagnostic accuracy analysis. The prevalence of hydronephrosis in our cohort was 33% (95% CI 25-41%). PoCUS had a sensitivity of 85% (95% CI 71-94%) and specificity of 78% (95% CI 68-87%) for the detection of hydronephrosis. CONCLUSION We describe the test characteristics of PoCUS for the detection of hydronephrosis in a cohort of patients with acute kidney injury. The low uptake of this test presents an opportunity for quality improvement work to increase its use for this indication.
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Affiliation(s)
- Mathilde Gaudreau-Simard
- Division of General Internal Medicine, The Ottawa Hospital-General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Tana Saiyin
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Matthew D F Mcinnes
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Diagnostic Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Sydney Ruller
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Edward G Clark
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Nephrology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Krista Wooller
- Division of General Internal Medicine, The Ottawa Hospital-General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Elaine Kilabuk
- Division of General Internal Medicine, The Ottawa Hospital-General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alan J Forster
- Division of General Internal Medicine, The Ottawa Hospital-General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Michael Y Woo
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
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3
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Güllüpınar B, Ayvat P, Ünlüer EE, Koran S. Evaluation of Patients Admitted to the Emergency Department with the Suspect of Acute Renal Colic with the Modified STONE Score. EURASIAN JOURNAL OF EMERGENCY MEDICINE 2022. [DOI: 10.4274/eajem.galenos.2021.44711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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4
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Celano T. Severe Hydronephrosis Secondary to Ovarian Serous Carcinoma. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221078835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This case study examines a patient with severe hydronephrosis caused by ureteral obstruction, secondary to ovarian serous carcinoma. Gynecologic malignancies, especially advanced ovarian carcinoma, are common extrinsic causes of obstructive hydronephrosis. Sonography is a valuable modality to visualize the kidneys, diagnose hydronephrosis, and determine the grade of hydronephrosis. The treatment of hydronephrosis aims to remove the build-up of urine, prevent permanent kidney damage, and treat the underlying cause. Prolonged or severe cases of hydronephrosis can lead to acute kidney injury.
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Affiliation(s)
- Trina Celano
- Ultrasound Department, University of Colorado Health, Aurora, CO, USA
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5
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Bourcier JE, Gallard E, Redonnet JP, Abillard M, Billaut Q, Fauque L, Jouanolou A, Garnier D. Ultrasound at the patient's bedside for the diagnosis and prognostication of a renal colic. Ultrasound J 2021; 13:45. [PMID: 34807330 PMCID: PMC8608963 DOI: 10.1186/s13089-021-00246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background Diagnosing a ureteral colic is sometimes difficult; however, clinicians should not fail to detect a surgical emergency. This is why diagnostic strategies depend on the imaging examinations, especially ultrasound. Prior studies have investigated the accuracy of Point of Care Ultrasound (PoCUS), but there are relatively few. This study aimed to evaluate the performance of the PoCUS in the diagnosis of renal colic. The secondary objective was to evaluate the relationship between the imaging results and the treatment performed. Methods After the clinical evaluation of patients aged > 18 years with suspected ureteral colic, the Emergency Physician (EP) trained in ultrasound performed PoCUS to conclude whether a diagnosis of “renal colic” should be made. A computed tomography (CT) examination was subsequently performed, to determine whether ureteral or bladder lithiasis was present to diagnose a ureteral colic. The patient’s management was decided according to the to degree of urinary tract dilatation, presence of perinephric fluid, size, and localization of stones. Results Of the 12 Eps in our units, seven met the training criteria for the inclusion of patients. A total of 103 patients were analyzed, and the renal colic diagnosis was retained in 85 cases after the CT examination. The accuracy of PoCUS was 91% (86; 95%) for detecting urinary tract dilatation, 83% (76; 90%) for detecting perinephric fluid, and 54% (44; 64%) for detecting lithiasis. Only high urinary tract stones with ≥ 6 mm diameter were surgically managed (p < 0.01). Conversely, distal ureteral stones with a diameter of < 6 mm were managed with medical ambulatory treatment (p < 0.05). Conclusion PoCUS is a good diagnostic tool, for renal colic, and could help reduce the requirement for the CT examinations and, hence, reduce induced radiation exposure.
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Affiliation(s)
- Jean-Eudes Bourcier
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France. .,Pôle Anesthésie-Réanimation-Urgences, Hôpital de Lourdes, 2 Avenue Alexandre Marqui, 65100, Lourdes, France.
| | - Emeric Gallard
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Jean-Philippe Redonnet
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Morgan Abillard
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Quentin Billaut
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Laura Fauque
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Anna Jouanolou
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Didier Garnier
- Emergency, Anesthesiology and Critical Care Department, Lourdes Hospital, Lourdes, France
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Innes GD, Scheuermeyer FX, McRae AD, Teichman JMH, Lane DJ. Hydronephrosis severity clarifies prognosis and guides management for emergency department patients with acute ureteral colic. CAN J EMERG MED 2021; 23:687-695. [PMID: 34304393 DOI: 10.1007/s43678-021-00168-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In emergency department patients with ureteral colic, the prognostic value of hydronephrosis is unclear. Our goal was to determine whether hydronephrosis can differentiate low-risk patients appropriate for trial of spontaneous passage from those with clinically important stones likely to experience passage failure. METHODS We used administrative data and structured chart review to evaluate a consecutive cohort of patients with ureteral stones who had a CT at nine Canadian hospitals in two cities. We used CT, the gold standard for stone imaging, to assess hydronephrosis and stone size. We described classification accuracy of hydronephrosis severity for detecting large (≥ 5 mm) stones. In patients attempting spontaneous passage we used hierarchical Bayesian regression to determine the association of hydronephrosis with passage failure, defined by the need for rescue intervention within 60 days. To illustrate prognostic utility, we reported pre-test probability of passage failure among all eligible patients (without hydronephrosis guidance) to post-test probability of passage failure in each hydronephrosis group. RESULTS Of 3251 patients, 70% male and mean age 51, 38% had a large stone, including 23%, 29%, 53% and 72% with absent, mild, moderate and severe hydronephrosis. Passage failure rates were 15%, 20%, 28% and 43% in the respective hydronephrosis categories, and 23% overall. "Absent or mild" hydronephrosis identified a large subset of patients (64%) with low passage failure rates. Moderate hydronephrosis predicted slightly higher, and severe hydronephrosis substantially higher passage failure risk. CONCLUSIONS Absent and mild hydronephrosis identify low-risk patients unlikely to experience passage failure, who may be appropriate for trial of spontaneous passage without CT imaging. Moderate hydronephrosis is weakly associated with larger stones but not with significantly greater passage failure. Severe hydronephrosis is an important finding that warrants definitive imaging and referral. Differentiating "moderate-severe" from "absent-mild" hydronephrosis provides risk stratification value. More granular hydronephrosis grading is not prognostically helpful.
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Affiliation(s)
- Grant D Innes
- Department of Emergency Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
| | - Frank X Scheuermeyer
- Department of Emergency Medicine, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Andrew D McRae
- Department of Emergency Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Joel M H Teichman
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Daniel J Lane
- Faculty of Medicine, University of Calgary, Calgary, AB, Canada
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7
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Sibley S, Roth N, Scott C, Rang L, White H, Sivilotti MLA, Bruder E. Point-of-care ultrasound for the detection of hydronephrosis in emergency department patients with suspected renal colic. Ultrasound J 2020; 12:31. [PMID: 32507905 PMCID: PMC7276462 DOI: 10.1186/s13089-020-00178-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/26/2020] [Indexed: 11/17/2022] Open
Abstract
Background 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. 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. Results 413 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. Conclusions PoCUS 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
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Affiliation(s)
- Stephanie Sibley
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada.
| | - Nathan Roth
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Charles Scott
- Department of Radiology, Queen's University, Kingston, ON, Canada
| | - Louise Rang
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - Heather White
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | | | - Eric Bruder
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
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8
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Ilgi M, Bayar G, Abdullayev E, Cakmak S, Acinikli H, Kirecci SL, Horasanli K. Rare Causes of Hydronephrosis in Adults and Diagnosis Algorithm: Analysis of 100 Cases During 15 Years. Cureus 2020; 12:e8226. [PMID: 32582487 PMCID: PMC7306661 DOI: 10.7759/cureus.8226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Hydronephrosis (HN) is a common pathology that is with/without obstruction. HN should be promptly addressed; otherwise, it progresses to cause impaired kidney function. This study was conducted to define the diagnosis algorithm and poor prognostic parameters used to evaluate unknown HN. Materials and Methods This study enrolled 100 patients who were over 20 years of age and were admitted to the center between 2001 and 2015 for the diagnosis and treatment of HN. Although initial diagnostic tests were applied, the HN etiology of the patients could not be found in ambulatory conditions; therefore, they were hospitalized to seek the causes for their HN. Patients who had a malignancy or tuberculosis or any previous ureteral injury were excluded. Results Of these cases, 29 were on both sides, whereas 42 were on the left side. Despite further investigations, the etiology was not determined in five patients. The frequency of malignancy in patients with hematuria (5/15) was two times higher than in patients without hematuria (33% vs. 17.6%; p = 0.01). Additionally, the malignancy rate was significantly higher in patients with weight loss (100%) than those without weight loss (OR: 6.25; p < 0.001). Conclusions Further investigation is recommended to define the precise etiology of HN. Hematuria and weight loss should be considered poor predictive factors during diagnosis.
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Affiliation(s)
- Musab Ilgi
- Urology, Hopa State Hospital, Artvin, TUR
| | | | | | - Sedat Cakmak
- Urology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, TUR
| | | | - Sinan L Kirecci
- Urology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, TUR
| | - Kaya Horasanli
- Urology, Sisli Hamidiye Etfal Research and Training Hopsital, University of Health Sciences, Istanbul, TUR
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9
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Himelfarb J, Lakhani A, Shelton D. Appropriate use of CT for patients presenting with suspected renal colic: a quality improvement study. BMJ Open Qual 2019; 8:e000470. [PMID: 31909206 PMCID: PMC6937084 DOI: 10.1136/bmjoq-2018-000470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/13/2019] [Accepted: 11/23/2019] [Indexed: 11/03/2022] Open
Abstract
Introduction CT use for renal colic has increased costs, radiation exposure and frequently does not alter management. Consequently, choosing wisely (CW) recommends avoiding CT imaging of otherwise healthy patients younger than 50 years presenting with symptoms of recurrent, uncomplicated renal colic. We evaluated the utilisation of CT imaging for this subgroup of patients and subsequently implemented a quality improvement initiative with an aim to reduce unnecessary radiation exposure. Methods A retrospective chart review was performed for all patients younger than 50 years who visited Sunnybrook Health Sciences Centre emergency department (ED) between December 2015 and May 2016 with a discharge diagnosis of renal colic. After the audit period, emergency physicians were engaged to perform a root cause analysis and a driver diagram was developed. In December 2016, a clinical decision tool was introduced to standardise the imaging for patients with presumed renal colic. In May 2017, a separate electronic order was created for low-dose CT for renal colic, including a prompt to remind clinicians of the CW recommendation. The impact of these changes was measured over 15 months. Results Over the initial audit period, 17/63 (27%) of our target population received a CT to rule out renal colic. Many patients received multiple CT scans for renal colic during past ED visits, while one received a total of 13 CTs. At the time of our interventions, the baseline rate of CT scans in our target population was 37%, which reduced to 29% after our project began. Conclusion CT is often used as an initial diagnostic modality for suspected recurrent renal colic despite current guidelines. While this initiative caused only a modest change in management, it led to the introduction of a new low-dose CT scan order specifically to reduce radiation exposure in patients at risk for repeat scans.
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Affiliation(s)
- Jonah Himelfarb
- Department of Internal Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Anand Lakhani
- Department of Obstetrics and Gynaecology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Dominick Shelton
- Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Emergency Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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Kim SG, Jo IJ, Kim T, Hwang SY, Park JH, Shin TG, Sim MS, Cha WC, Yoon H. Usefulness of Protocolized Point-of-Care Ultrasonography for Patients with Acute Renal Colic Who Visited Emergency Department: A Randomized Controlled Study. ACTA ACUST UNITED AC 2019; 55:medicina55110717. [PMID: 31661942 PMCID: PMC6915595 DOI: 10.3390/medicina55110717] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/07/2019] [Accepted: 10/25/2019] [Indexed: 11/29/2022]
Abstract
Background and Objectives: Ultrasonography is useful in evaluating patients with renal colic and it has high sensitivity and specificity for diagnosing ureter stones by revealing hydronephrosis. We evaluated the efficacy of point-of-care ultrasonography protocol in managing patients with acute renal colic who visited the emergency department (ED). Materials and Methods: Between March 2019 and July 2019, patients who visited the ED because of renal colic were randomly assigned by date of visit either to the conventional group (CG), who underwent routine diagnostic work-up without ultrasonography, or to the ultrasonography group (UG), who underwent bedside ultrasonography as an initial diagnostic testing. When hydronephrosis was detected in the UG group, a confirmatory non-contrast abdomen computed tomography scan was promptly performed. The ED length of stay, complications, and missed or delayed high-risk diagnosis were evaluated. Results: In total, 128 of 147 analyzed patients were confirmed to have ureter stones. The ED length of stay was significantly lower in the UG group than in the CG group (mean 172 min; 95% confidence interval (CI): 151–194 min vs. mean 234 min; 95% CI: 216–252 min). The medical cost was also remarkably lower in the UG group than in the CG group (259 USD vs. 319 USD; p < 0.001). The incidence of complications within 30 days after visiting ED and missed or delayed high-risk diagnosis were not significantly different between the two groups. Conclusions: We found that protocolized point-of-care ultrasonography in patients with acute renal colic who visited the ED can more effectively reduce the length of stay and medical cost without 30-day complication than usual clinical practice.
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Affiliation(s)
- Seok Goo Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
| | - Joo Hyun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
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11
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Marasco G, Verardi FM, Eusebi LH, Guarino S, Romiti A, Vestito A, Bazzoli F, Cavazza M, Zagari RM. Diagnostic imaging for acute abdominal pain in an Emergency Department in Italy. Intern Emerg Med 2019; 14:1147-1153. [PMID: 31493199 DOI: 10.1007/s11739-019-02189-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/30/2019] [Indexed: 12/22/2022]
Abstract
Imaging plays a key role in the diagnostic work-up of patients with non-traumatic acute abdominal pain (AAP) in emergency department (ED). We aimed to evaluate the use and diagnostic performance of imaging techniques in adult patients with AAP in an ED in Italy. Patients with non-traumatic AAP admitted at the ED of S. Orsola-Malpighi University Hospital of Bologna (Italy) from the 1st to the 30th November 2016 were included. Demographic and clinical data, data on radiological procedures and discharge diagnosis were collected. Sensitivity and specificity for detecting acute diseases were assessed using the discharge diagnosis from the ED as reference standard. Of the 578 patients (female 52.8%, mean age 51.3 years) admitted to the ED for AAP, 433 (74.9%) underwent abdominal imaging. The most frequent techniques used were abdominal plain radiography and ultrasonography (US), performed in 38.4% and 37.9% of patients, respectively, followed by computed tomography (CT) in 28% of patients. Plain radiography yielded a sensitivity of 28% and specificity of 91.1%; the sensitivity increased to 79.4% in patients with small bowel obstruction. Ultrasonography's sensitivity and specificity were 61.8% and 98.4%, respectively; the sensitivity of US reached 85.2% and 90% in patients with acute cholecystitis/biliary colic and urolithiasis, respectively. The sensitivity and specificity of CT were 87.8% and 92.9%, respectively. Plain radiography is still overused in the diagnostic work-up of AAP in ED in Italy, despite its unsatisfactory sensitivity. Ultrasonography and CT has a higher sensitivity and should be used as first-level imaging in most patients.
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Affiliation(s)
- Giovanni Marasco
- Department of Medical and Surgical Sciences, University of Bologna, Policlinico S. Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy
| | - Filippo Maria Verardi
- Department of Medical and Surgical Sciences, University of Bologna, Policlinico S. Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy
| | - Leonardo Henry Eusebi
- Department of Medical and Surgical Sciences, University of Bologna, Policlinico S. Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy
| | - Sonia Guarino
- Department of Medical and Surgical Sciences, University of Bologna, Policlinico S. Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy
| | - Alessandra Romiti
- Department of Medical and Surgical Sciences, University of Bologna, Policlinico S. Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy
| | - Amanda Vestito
- Department of Medical and Surgical Sciences, University of Bologna, Policlinico S. Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy
| | - Franco Bazzoli
- Department of Medical and Surgical Sciences, University of Bologna, Policlinico S. Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy
| | - Mario Cavazza
- Emergency Department, S. Orsola-Malpighi Hospital, Via Massarenti 9, Bologna, Italy
| | - Rocco Maurizio Zagari
- Department of Medical and Surgical Sciences, University of Bologna, Policlinico S. Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy.
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Hopkins A, Doniger SJ. Point-of-Care Ultrasound for the Pediatric Hospitalist's Practice. Hosp Pediatr 2019; 9:707-718. [PMID: 31405888 DOI: 10.1542/hpeds.2018-0118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Point-of-care ultrasound (POCUS) has the potential to provide real-time valuable information that could alter diagnosis, treatment, and management practices in pediatric hospital medicine. We review the existing pediatric POCUS literature to identify potential clinical applications within the scope of pediatric hospital medicine. Diagnostic point-of-care applications most relevant to the pediatric hospitalist include lung ultrasound for pneumothorax, pleural effusion, pneumonia, and bronchiolitis; cardiac ultrasound for global cardiac function and hydration status; renal or bladder ultrasound for nephrolithiasis, hydronephrosis, and bladder volumes; soft tissue ultrasound for differentiating cellulitis from abscess; and procedural-guidance applications, including line placement, lumbar puncture, and abscess incision and drainage. We discuss POCUS applications with reviews of major pathologic findings, research gaps, the integration of POCUS into practice, and barriers to implementation.
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Affiliation(s)
- Akshata Hopkins
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida; and
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13
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Pathan SA, Mitra B, Mirza S, Momin U, Ahmed Z, Andraous LG, Shukla D, Shariff MY, Makki MM, George TT, Khan SS, Thomas SH, Cameron PA. Emergency Physician Interpretation of Point-of-care Ultrasound for Identifying and Grading of Hydronephrosis in Renal Colic Compared With Consensus Interpretation by Emergency Radiologists. Acad Emerg Med 2018; 25:1129-1137. [PMID: 29663580 DOI: 10.1111/acem.13432] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 03/06/2018] [Accepted: 04/09/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The ability of emergency physicians (EPs) to identify hydronephrosis using point-of-care ultrasound (POCUS) has been assessed in the past using computed tomography (CT) scans as the reference standard. We aimed to determine the ability of EPs to identify and grade hydronephrosis on POCUS using the consensus interpretation of POCUS by emergency radiologists as the reference standard. METHODS The study was conducted at an urban academic emergency department (ED) as a secondary analysis of previously collected ultrasound data from the EP-performed POCUS databank. Patients were eligible for inclusion if they had both POCUS and CT scanning performed during the index ED visit. Two board-certified emergency radiologists and six EPs interpreted each POCUS study independently. The interpretations were compared with the consensus interpretation by emergency radiologists. Additionally, the POCUS interpretations were also compared with the corresponding CT findings. Institutional approval was obtained for conducting this study. All the analyses were performed using Stata MP 14.0 (StataCorp). RESULTS A total of 651 patient image-data sets were eligible for inclusion in this study. Hydronephrosis was reported in 69.6% of POCUS examinations by radiologists and 72.7% of CT scans (p = 0.22). Using the consensus radiology interpretation of POCUS as the reference standard, EPs had an overall sensitivity of 85.7% (95% confidence interval [CI] = 84.3%-87.0%), specificity of 65.9% (95% CI = 63.1%-68.7%), positive likelihood ratio of 2.5 (95% CI = 2.3-2.7), and negative likelihood ratio of 0.22 (95% CI = 0.19-0.24) for hydronephrosis. When using CT scan as the reference standard, the EPs had an overall sensitivity of 81.1% (95% CI = 79.6% to 82.5%), specificity of 59.4% (95% CI = 56.4%-62.5%), positive likelihood ratio of 2.0 (95% CI = 1.8-2.2), and negative likelihood ratio of 0.32 (95% CI = 0.29-0.35) for hydronephrosis. The specificity of EPs was improved to 94.6% (95% CI = 93.7%-95.4%) for categorizing the degree of hydronephrosis as "moderate or severe" versus "none or mild," with positive likelihood ratio of 6.33 (95% CI = 5.3-7.5) and negative likelihood ratio of 0.69 (95% CI = 0.66-0.73). CONCLUSIONS Emergency physicians were found to have moderate to high sensitivity for identifying hydronephrosis on POCUS when compared with the consensus interpretation of the same studies by emergency radiologists. These POCUS findings by EPs produced more definitive results when at least moderate degree of hydronephrosis was present.
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Affiliation(s)
- Sameer A. Pathan
- Emergency Department Hamad General Hospital Hamad Medical Corporation DohaQatar
- Department of Epidemiology & Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne Australia
- National Trauma Research Institute The Alfred Hospital MelbourneAustralia
| | - Biswadev Mitra
- Department of Epidemiology & Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne Australia
- National Trauma Research Institute The Alfred Hospital MelbourneAustralia
- Emergency & Trauma Centre The Alfred Hospital Melbourne Australia
| | - Salman Mirza
- Emergency Radiology Section Radiology Department Hamad General Hospital Hamad Medical Corporation DohaQatar
| | - Umais Momin
- Emergency Radiology Section Radiology Department Hamad General Hospital Hamad Medical Corporation DohaQatar
| | - Zahoor Ahmed
- Emergency Radiology Section Radiology Department Hamad General Hospital Hamad Medical Corporation DohaQatar
| | - Lubna G. Andraous
- Emergency Department Hamad General Hospital Hamad Medical Corporation DohaQatar
| | - Dharmesh Shukla
- Emergency Department Hamad General Hospital Hamad Medical Corporation DohaQatar
| | - Mohammed Y. Shariff
- Emergency Department Hamad General Hospital Hamad Medical Corporation DohaQatar
| | - Magid M. Makki
- Emergency Department Hamad General Hospital Hamad Medical Corporation DohaQatar
| | - Tinsy T. George
- Emergency Department Hamad General Hospital Hamad Medical Corporation DohaQatar
| | - Saad S. Khan
- Emergency Department Hamad General Hospital Hamad Medical Corporation DohaQatar
| | - Stephen H. Thomas
- Emergency Department Hamad General Hospital Hamad Medical Corporation DohaQatar
- Weill Cornell Medical College in Qatar Education City Doha Qatar
| | - Peter A. Cameron
- Department of Epidemiology & Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne Australia
- National Trauma Research Institute The Alfred Hospital MelbourneAustralia
- Emergency & Trauma Centre The Alfred Hospital Melbourne Australia
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Dversdal RK, Piro KM, LoPresti CM, Northcutt NM, Schnobrich DJ. Point-of-Care Ultrasound in the Inpatient Setting: A Tale of Four Patients. South Med J 2018; 111:382-388. [DOI: 10.14423/smj.0000000000000837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Wong C, Teitge B, Ross M, Young P, Robertson HL, Lang E. The Accuracy and Prognostic Value of Point-of-care Ultrasound for Nephrolithiasis in the Emergency Department: A Systematic Review and Meta-analysis. Acad Emerg Med 2018; 25:684-698. [PMID: 29427476 DOI: 10.1111/acem.13388] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 11/09/2017] [Accepted: 11/14/2017] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Point-of-care ultrasound (POCUS) has been suggested as an initial investigation in the management of renal colic. Our objectives were: 1) to determine the accuracy of POCUS for the diagnosis of nephrolithiasis and 2) to assess its prognostic value in the management of renal colic. METHODS The review protocol was registered to the PROSPERO database (CRD42016035331). An electronic database search of MEDLINE, Embase, and PubMed was conducted utilizing subject headings, keywords, and synonyms that address our research question. Bibliographies of included studies and narrative reviews were manually examined. Studies of adult emergency department patients with renal colic symptoms were included. Any degree of hydronephrosis was considered a positive POCUS finding. Accepted criterion standards were computed tomography evidence of renal stone or hydronephrosis, direct stone visualization, or surgical findings. Screening of abstracts, quality assessment with the QUADAS-2 instrument, and data extraction were performed by two reviewers, with discrepancies resolved by consensus with a third reviewer. Test performance was assessed by pooled sensitivity and specificity, calculated likelihood ratios, and a summary receiver operator curve (SROC). The secondary objective of prognostic value was reported as a narrative summary. RESULTS The electronic search yielded 627 unique titles. After relevance screening, 26 papers underwent full-text review, and nine articles met all inclusion criteria. Of these, five high-quality studies (N = 1,773) were included in the meta-analysis for diagnostic accuracy and the remaining yielded data on prognostic value. The pooled results for sensitivity and specificity were 70.2% (95% confidence interval [CI] = 67.1%-73.2%) and 75.4% (95% CI = 72.5%-78.2%), respectively. The calculated positive and negative likelihood ratios were 2.85 and 0.39. The SROC generated did not show evidence of a threshold effect. Two of the studies in the meta-analysis found that the finding of moderate or greater hydronephrosis yielded a specificity of 94.4% (95% CI = 92.7%-95.8%). Four studies examining prognostic value noted a higher likelihood of a large stone when positive POCUS findings were present. The largest randomized trial showed lower cumulative radiation exposure and no increase in adverse events in those who received POCUS investigation as the initial renal colic investigation. CONCLUSION Point-of-care ultrasound has modest diagnostic accuracy for diagnosing nephrolithiasis. The finding of moderate or severe hydronephrosis is highly specific for the presence of any stone, and the presence of any hydronephrosis is suggestive of a larger (>5 mm) stone in those presenting with renal colic.
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Affiliation(s)
- Charles Wong
- Department of Emergency MedicineUniversity of Calgary Calgary AB Canada
- Cumming School of Medicine University of Calgary Calgary AB Canada
| | - Braden Teitge
- Department of Emergency MedicineUniversity of Calgary Calgary AB Canada
| | - Marshall Ross
- Department of Emergency MedicineUniversity of Calgary Calgary AB Canada
| | - Paul Young
- Department of Family MedicineUniversity of Calgary Calgary AB Canada
| | | | - Eddy Lang
- Department of Emergency MedicineUniversity of Calgary Calgary AB Canada
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Mills L, Morley EJ, Soucy Z, Vilke GM, Lam SHF. Ultrasound for the Diagnosis and Management of Suspected Urolithiasis in the Emergency Department. J Emerg Med 2017; 54:215-220. [PMID: 29089155 DOI: 10.1016/j.jemermed.2017.09.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 09/18/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND This review provides practicing emergency physicians updated information regarding point-of-care ultrasound (POCUS) imaging of patients with suspected urolithiasis. METHODS A PubMed literature search was conducted for articles published between January 1, 1996 and May 31, 2017 and limited to human clinical trials written in English with relevant keywords. High-quality studies identified then underwent a structured review. Recommendations herein are made based on the literature review. RESULTS Two hundred seventy-two abstracts fulfilling the search criteria were screened and 10 appropriate articles were rigorously reviewed in detail. There were 8 prospective studies and 2 retrospective studies. Only 1 of them was a multi-institutional randomized trial. POCUS performed in the emergency department (ED) is moderately sensitive and specific in making the diagnosis of urolithiasis in symptomatic patients. Suspected urolithiasis patients evaluated initially with ED POCUS have complication rates compatible with those evaluated initially with computed tomography. CONCLUSIONS POCUS has moderate accuracy in making the diagnosis of urolithiasis. Nevertheless, it may be safely used as a first line of imaging in ED patients with suspected symptomatic urolithiaisis.
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Affiliation(s)
- Lisa Mills
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, California
| | - Eric J Morley
- Department of Emergency Medicine, Stony Brook University, Stony Brook, New York
| | - Zachary Soucy
- Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - Gary M Vilke
- Department of Emergency Medicine, University of California, San Diego, San Diego, California
| | - Samuel H F Lam
- Department of Emergency Medicine, University of California, San Diego, San Diego, California
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Leo MM, Langlois BK, Pare JR, Mitchell P, Linden J, Nelson KP, Amanti C, Carmody KA. Ultrasound vs. Computed Tomography for Severity of Hydronephrosis and Its Importance in Renal Colic. West J Emerg Med 2017; 18:559-568. [PMID: 28611874 PMCID: PMC5468059 DOI: 10.5811/westjem.2017.04.33119] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/04/2017] [Accepted: 04/25/2017] [Indexed: 12/20/2022] Open
Abstract
Introduction Supporting 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. Methods This 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. Results We 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). Conclusion Using 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.
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Affiliation(s)
- Megan M Leo
- Boston University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts.,Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Breanne K Langlois
- Tufts University, Friedman School of Nutrition Science and Policy, Boston, Massachusetts
| | - Joseph R Pare
- Boston University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts.,Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Patricia Mitchell
- Boston University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts.,Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Judith Linden
- Boston University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts.,Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Kerrie P Nelson
- Boston University, School of Public Health, Boston, Massachusetts
| | - Cristopher Amanti
- Boston University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts.,Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Kristin A Carmody
- New York University School of Medicine, Department of Emergency Medicine, New York, New York
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Marin JR, Abo AM, Arroyo AC, Doniger SJ, Fischer JW, Rempell R, Gary B, Holmes JF, Kessler DO, Lam SHF, Levine MC, Levy JA, Murray A, Ng L, Noble VE, Ramirez-Schrempp D, Riley DC, Saul T, Shah V, Sivitz AB, Tay ET, Teng D, Chaudoin L, Tsung JW, Vieira RL, Vitberg YM, Lewiss RE. Pediatric emergency medicine point-of-care ultrasound: summary of the evidence. Crit Ultrasound J 2016; 8:16. [PMID: 27812885 PMCID: PMC5095098 DOI: 10.1186/s13089-016-0049-5] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/01/2016] [Indexed: 12/19/2022] Open
Abstract
The utility of point-of-care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, the American Academy of Pediatrics published a policy statement endorsing the use of point-of-care ultrasound by pediatric emergency medicine providers. To date, there is no standard guideline for the practice of point-of-care ultrasound for this specialty. This document serves as an initial step in the detailed "how to" and description of individual point-of-care ultrasound examinations. Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting guidelines.
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Affiliation(s)
- Jennifer R. Marin
- Children’s Hospital of Pittsburgh, 4401 Penn Ave, AOB Suite 2400, Pittsburgh, PA 15224 USA
| | - Alyssa M. Abo
- Children’s National Medical Center, Washington DC, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Lorraine Ng
- Morgan Stanley Children’s Hospital, New York, NY USA
| | | | | | | | | | | | | | | | - David Teng
- Cohen Children’s Medical Center, New Hyde Park, USA
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19
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Kameda T, Taniguchi N. Overview of point-of-care abdominal ultrasound in emergency and critical care. J Intensive Care 2016; 4:53. [PMID: 27529029 PMCID: PMC4983797 DOI: 10.1186/s40560-016-0175-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 07/12/2016] [Indexed: 01/16/2023] Open
Abstract
Point-of-care abdominal ultrasound (US), which is performed by clinicians at bedside, is increasingly being used to evaluate clinical manifestations, to facilitate accurate diagnoses, and to assist procedures in emergency and critical care. Methods for the assessment of acute abdominal pain with point-of-care US must be developed according to accumulated evidence in each abdominal region. To detect hemoperitoneum, the methodology of a focused assessment with sonography for a trauma examination may also be an option in non-trauma patients. For the assessment of systemic hypoperfusion and renal dysfunction, point-of-care renal Doppler US may be an option. Utilization of point-of-care US is also considered in order to detect abdominal and pelvic lesions. It is particularly useful for the detection of gallstones and the diagnosis of acute cholecystitis. Point-of-case US is justified as the initial imaging modality for the diagnosis of ureterolithiasis and the assessment of pyelonephritis. It can be used with great accuracy to detect the presence of abdominal aortic aneurysm in symptomatic patients. It may also be useful for the diagnoses of digestive tract diseases such as appendicitis, small bowel obstruction, and gastrointestinal perforation. Additionally, point-of-care US can be a modality for assisting procedures. Paracentesis under US guidance has been shown to improve patient care. US appears to be a potential modality to verify the placement of the gastric tube. The estimation of the amount of urine with bladder US can lead to an increased success rate in small children. US-guided catheterization with transrectal pressure appears to be useful in some male patients in whom standard urethral catheterization is difficult. Although a greater accumulation of evidences is needed in some fields, point-of-care abdominal US is a promising modality to improve patient care in emergency and critical care settings.
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Affiliation(s)
- Toru Kameda
- Department of Emergency Medicine, Red Cross Society Azumino Hospital, 5685 Toyoshina, Azumino, Nagano 399-8292 Japan
| | - Nobuyuki Taniguchi
- Department of Clinical Laboratory Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
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Duchenne J, Martinez M, Rothmann C, Claret PG, Desclefs JP, Vaux J, Miroux P, Ganansia O. Premier niveau de compétence pour l’échographie clinique en médecine d’urgence. Recommandations de la Société française de médecine d’urgence par consensus formalisé. ANNALES FRANCAISES DE MEDECINE D URGENCE 2016. [DOI: 10.1007/s13341-016-0649-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Marin JR, Lewiss RE. Point-of-care ultrasonography by pediatric emergency physicians. Policy statement. Ann Emerg Med 2016; 65:472-8. [PMID: 25805037 DOI: 10.1016/j.annemergmed.2015.01.028] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Indexed: 01/10/2023]
Abstract
Point-of-care ultrasonography is increasingly being used to facilitate accurate and timely diagnoses and to guide procedures. It is important for pediatric emergency physicians caring for patients in the emergency department to receive adequate and continued point-of-care ultrasonography training for those indications used in their practice setting. Emergency departments should have credentialing and quality assurance programs. Pediatric emergency medicine fellowships should provide appropriate training to physician trainees. Hospitals should provide privileges to physicians who demonstrate competency in point-of-care ultrasonography. Ongoing research will provide the necessary measures to define the optimal training and competency assessment standards. Requirements for credentialing and hospital privileges will vary and will be specific to individual departments and hospitals. As more physicians are trained and more research is completed, there should be one national standard for credentialing and privileging in point-of-care ultrasonography for pediatric emergency physicians.
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Crossed Fused Renal Ectopia Diagnosed After Discovering an Absent Left Kidney by Point-of-Care Ultrasound. Pediatr Emerg Care 2016; 32:56-7. [PMID: 26720068 DOI: 10.1097/pec.0000000000000671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report an incidental diagnosis of crossed fused renal ectopia diagnosed in a patient initially evaluated with an educational point-of-care ultrasound (US). We review the US technique, sonographic findings, and the relevant literature regarding renal US.
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24
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Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients—Part I. Crit Care Med 2015; 43:2479-502. [DOI: 10.1097/ccm.0000000000001216] [Citation(s) in RCA: 232] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Tran VH, Nelson M, Nogar J, Bramante RM. Bilateral hydronephrosis and cystitis resulting from chronic ketamine abuse. West J Emerg Med 2015; 15:382-4. [PMID: 25035738 PMCID: PMC4100838 DOI: 10.5811/westjem.2014.4.20571] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 03/10/2014] [Indexed: 11/11/2022] Open
Abstract
Ketamine associated urinary dysfunction has become increasingly more common worldwide. Point-of-care ultrasound (POCUS) is an established modality for diagnosing hydronephrosis in the emergency department. We describe a case of a young male ketamine abuser with severe urinary urgency and frequency in which POCUS performed by the emergency physician demonstrated bilateral hydronephrosis and a focally thickened irregular shaped bladder. Emergency physicians should consider using POCUS evaluate for hydronephrosis and bladder changes in ketamine abusers with lower urinary tract symptoms. The mainstay of treatment is discontinuing ketamine abuse.
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Affiliation(s)
- Vu Huy Tran
- Albert Einstein College of Medicine, Jack D. Weiler Hospital, Bronx, New York
| | - Mathew Nelson
- Hofstra North Shore-LIJ School of Medicine, Department of Emergency Medicine, Hempstead, New York
| | - Joshua Nogar
- Hofstra North Shore-LIJ School of Medicine, Department of Emergency Medicine, Hempstead, New York
| | - Robert M Bramante
- Hofstra North Shore-LIJ School of Medicine, Department of Emergency Medicine, Hempstead, New York
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The utility of renal ultrasonography in the diagnosis of renal colic in emergency department patients. CAN J EMERG MED 2015; 12:201-6. [DOI: 10.1017/s1481803500012240] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACT
Objective:
Computed tomography (CT) is an imaging modality used to detect renal stones. However, there is concern about the lifetime cumulative radiation exposure attributed to CT. Ultrasonography (US) has been used to diagnose urolithiasis, thereby avoiding radiation exposure. The objective of this study was to determine the ability of US to identify renal colic patients with a low risk of requiring urologic intervention within 90 days of their initial emergency department (ED) visit.
Methods:
We completed a retrospective medical record review for all adult patients who underwent ED-ordered renal US for suspected urolithiasis over a 1-year period. Independent, double data extraction was performed for all imaging reports and US results were categorized as “normal,” “suggestive of ureterolithiasis,” “ureteric stone seen” or “disease unrelated to urolithiasis.” Charts were reviewed to determine how many patients underwent subsequent CT and urologic intervention.
Results:
Of the 817 renal US procedures ordered for suspected urolithiasis during the study period, the results of 352 (43.2%) were classified as normal, and only 2 (0.6%) of these patients required urologic intervention. The results of 177 (21.7%) renal US procedures were suggestive of ureterolithiasis. Of these, 12 (6.8%) patients required urologic intervention. Of the 241 (29.5%) patients who had a ureteric stone seen on US, 15 (6.2%) required urologic intervention. The rate of urologic intervention was significantly lower in those with normal results on US (p < 0.001) than in those with abnormal results on US.
Conclusion:
A normal result on renal US predicts a low likelihood for urologic intervention within 90 days for adult ED patients with suspected urolithiasis.
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Henneberry RJ, Hanson A, Healey A, Hebert G, Ip U, Mensour M, Mikhail P, Miller S, Socransky S, Woo M. Use of point of care sonography by emergency physicians. CAN J EMERG MED 2015; 14:106-12. [DOI: 10.2310/8000.caepps] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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29
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Dickman E, Tessaro MO, Arroyo AC, Haines LE, Marshall JP. Clinician-performed abdominal sonography. Eur J Trauma Emerg Surg 2015; 41:481-92. [PMID: 26038027 DOI: 10.1007/s00068-015-0508-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 03/02/2015] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Point-of-care ultrasonography is increasingly utilized across a wide variety of physician specialties. This imaging modality can be used to evaluate patients rapidly and accurately for a wide variety of pathologic conditions. METHODS A literature search was performed for articles focused on clinician-performed ultrasonography for the diagnosis of appendicitis, gallbladder disease, small bowel obstruction, intussusception, and several types of renal pathology. The findings of this search were summarized including the imaging techniques utilized in these studies. CONCLUSION Clinician performed point-of-care sonography is particularly well suited to abdominal applications. Future investigations may further confirm and extend its utility at the bedside.
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Affiliation(s)
- E Dickman
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, 11219, USA.
| | - M O Tessaro
- Division of Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, ON, M5G1X8, Canada
| | - A C Arroyo
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, 11219, USA
| | - L E Haines
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, 11219, USA
| | - J P Marshall
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, 11219, 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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Zwank MD, Ho BM, Gresback D, Stuck LH, Salzman JG, Woster WR. Does computed tomographic scan affect diagnosis and management of patients with suspected renal colic? Am J Emerg Med 2013; 32:367-70. [PMID: 24440589 DOI: 10.1016/j.ajem.2013.12.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 12/08/2013] [Accepted: 12/11/2013] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Patients with renal colic commonly present to the emergency department (ED) and are usually treated with analgesics, antiemetics and hydration. Computed tomographic (CT) scan is commonly utilized in evaluating patients with suspected renal colic. OBJECTIVES We compared diagnosis and treatment plans before and after CT in patients with suspected renal colic with the aim to evaluate how often changes in diagnosis, treatment and disposition are made. METHODS In this prospective observational study, we enrolled a convenience sample of clinically Stable ED patients older than 17 with suspected renal colic for whom CT was planned. Exclusion criteria were: chronic kidney disease, urinary tract infection, recent CT and history of previous kidney stone. Pre-CT and Post-CT surveys were completed by the treating provider. RESULTS The discharge diagnosis was renal colic in 62 of 93 enrolled patients (67%). Urinalysis showed blood in 52 of these patients (84%). CT confirmed obstructing kidney or bladder stone in 50 patients. There were five cases of alternative diagnoses noted on CT scan. After CT scan, 7 patients had changes in disposition. Sixteen providers felt that CT would not change management. In these cases, CT offered no alternative diagnosis and didn't change disposition. CONCLUSION CT scan didn't change management when providers did not expect it would. This indicates that providers who are confident with the diagnosis of renal colic should consider forgoing a CT scan. CT scan did occasionally find important alternative diagnoses and should be utilized when providers are considering other concerning pathology.
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Affiliation(s)
- Michael D Zwank
- Emergency Medicine Department, Regions Hospital, Saint Paul, MN, USA; University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Benjamin M Ho
- Department of Emergency Medicine, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - David Gresback
- Department of Emergency Medicine, Albany Medical College, Albany, NY, USA
| | - Logan H Stuck
- HealthPartners Institute for Education and Research, Bloomington, MN, USA
| | - Joshua G Salzman
- Critical Care Research Center, Regions Hospital, Saint Paul, MN, USA
| | - Wendy R Woster
- Emergency Medicine Department, Regions Hospital, Saint Paul, MN, USA
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Rafi M, Shetty A, Gunja N. Accuracy of computed tomography of the kidneys, ureters and bladder interpretation by emergency physicians. Emerg Med Australas 2013; 25:422-6. [PMID: 24099370 DOI: 10.1111/1742-6723.12117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The study aims to determine the interpretation accuracy of computed tomography of the kidneys, ureters and bladder (CT-KUB) by emergency physicians (EPs) compared with the formal radiology report, as the reference standard, in patients with suspected acute urinary tract calculous disease. METHODS A sample of 20 consecutive CT-KUB scans for suspected acute calculous disease was compiled from the medical imaging department of an adult tertiary teaching hospital. Ten EPs with a minimum of 2 years' experience post-Fellowship interpreted each scan using a template form. The total sample of 200 reports by EPs was compared with the formal radiology report for agreement in detecting renal tract stones, signs of obstruction and other clinical findings. Interrater agreement and the kappa statistic were used for comparative data analysis. RESULTS There was a high level of agreement (%, kappa value) between EPs and radiologists for the detection of large (≥5 mm) calculi (94.5%, κ 0.89), signs of obstruction (93%, κ 0.86) and clinically significant findings (90%, κ 0.78). The level of agreement was low for the detection of small (<5 mm) calculi (79%, κ 0.48) and clinically non-significant findings (67.5%, κ 0.33). CONCLUSION EPs can accurately detect clinically significant acute calculous disease and signs of obstruction on CT-KUB, allowing for ongoing acute management and early disposition of the patient. However, their findings should be verified against the formal radiology report when available.
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Affiliation(s)
- Momtaz Rafi
- Emergency Department, Nepean Hospital, Sydney, New South Wales, Australia
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Maurin O, De Regloix S, Lefort H, Delort G, Domanski L, Tourtier JP, Palmier B. French military general practitioner: ultrasound practice. J ROY ARMY MED CORPS 2013; 160:213-6. [DOI: 10.1136/jramc-2013-000082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bedside renal ultrasound in the evaluation of suspected ureterolithiasis. Am J Emerg Med 2012; 30:218-21. [DOI: 10.1016/j.ajem.2010.11.024] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 11/10/2010] [Accepted: 11/14/2010] [Indexed: 11/21/2022] Open
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Carnell J, Fischer J, Nagdev A. Ultrasound detection of obstructive pyelonephritis due to urolithiasis in the ED. Am J Emerg Med 2010; 29:843.e1-3. [PMID: 20934827 DOI: 10.1016/j.ajem.2010.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 07/01/2010] [Accepted: 07/07/2010] [Indexed: 11/18/2022] Open
Abstract
Identifying acute pyelonephritis (APN) with early obstructive uropathy is clinically important in the emergency department (ED) because obstructive urolithiasis is an independent risk factor for inpatient death, prolonged hospitalization, and failure of outpatient APN therapy. Furthermore, diagnosis of an early obstructive uropathy can be difficult when based solely on clinical findings. Clinicians may assume the cause of the patient's symptoms to be APN alone, without considering the concurrent presence of an obstructing stone. A feasible screening test to detect early obstructive uropathy in cases of APN has not been previously identified. Plain film radiographs are insensitive in locating a suspected calcified stone. Computed tomography is readily available in most EDs and clearly defines urologic anatomy, but delivers unnecessary ionizing radiation, can prolong ED length of stay, and is not cost-effective as a screening test for all patients diagnosed with APN. We report a case in which a bedside ultrasound identifying hydronephrosis prompted confirmatory computed tomography imaging and emergency consultation of a patient with APN. In this case, hydronephrosis on bedside ultrasound examination was an indirect marker of a distal ureteral obstruction. By detecting the presence of hydronephrosis in patients with APN, emergency physicians may dramatically increase their ability to identify those patients that need further radiographic investigation and ultimately decrease the rate of outpatient treatment failure. Further surveillance data are needed to determine the statistical characteristics of this novel screening test and if routine renal evaluation of all patients with APN is warranted.
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Affiliation(s)
- Jennifer Carnell
- Department of Emergency Medicine, Alameda County Medical Center, Highland Hospital, Oakland, CA 94602, USA.
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He W, Fischman AJ. Nuclear imaging in the genitourinary tract: recent advances and future directions. Radiol Clin North Am 2008; 46:25-43, v. [PMID: 18328878 DOI: 10.1016/j.rcl.2008.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
For almost three decades, noninvasive radionuclide procedures for the evaluation of renal disease have been important components of nuclear medicine practice. With the introduction of new imaging agents and procedures, these techniques can provide valuable data on perfusion and function of individual kidneys. In general, these procedures are easy to perform and carry a low radiation burden and sedation is not required. Moreover, radionuclide imaging of the genitourinary tract has become an invaluable asset to clinicians in the evaluation of renal parenchyma and urologic abnormalities.
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Affiliation(s)
- Wei He
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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