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

Published online by Cambridge University Press:  11 February 2015

Justin W. Yan ,
Shelley L. McLeod ,
Marcia L. Edmonds ,
Robert J. Sedran  and
Karl D. Theakston
Justin W. Yan*
Affiliation:
Division of Emergency Medicine, The University of Western Ontario, London, ON Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON
Shelley L. McLeod
Affiliation:
Division of Emergency Medicine, The University of Western Ontario, London, ON
Marcia L. Edmonds
Affiliation:
Division of Emergency Medicine, The University of Western Ontario, London, ON Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON
Robert J. Sedran
Affiliation:
Division of Emergency Medicine, The University of Western Ontario, London, ON Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON
Karl D. Theakston
Affiliation:
Division of Emergency Medicine, The University of Western Ontario, London, ON Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON
*
Correspondence to: Dr. Justin Yan, The University of Western Ontario - Emergency Medicine, E1-100 Westminster Tower, 800 Commissioners Road East, London, ON N6A 5W9; jyan2009@meds.uwo.ca.

Abstract

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Introduction

Determining which patients with ureterolithiasis are likely to require urologic intervention is a common challenge in the emergency department (ED). The objective was to determine if normal renal sonogram could identify low-risk renal colic patients, who were defined as not requiring urologic intervention within 90 days of their initial ED visit and can be managed conservatively.

Methods

This was a prospective cohort study involving adult patients presenting to the EDs of a tertiary care centre with suspected renal colic over a 20-month period. Renal ultrasonography (US) was performed in the diagnostic imaging department by trained ultrasonographers, and the results were categorized into four mutually exclusive groups: normal, suggestive of ureterolithiasis, visualized ureteric stone, or findings unrelated to urolithiasis. Electronic medical records were reviewed to determine if patients received urologic intervention within 90 days of their ED visit.

Results

Of 610 patients enrolled, 341 (55.9%) had US for suspected renal colic. Of those, 105 (30.8%) were classified as normal; none of these patients underwent urologic intervention within 90 days of their ED visit. Ninety (26.4%) US results were classified as suggestive, and nine (10%) patients received urologic intervention. A total of 139 (40.8%) US results were classified as visualized ureteric stone, and 34 (24.5%) patients had urologic intervention. Seven (2.1%) US results were classified as findings unrelated to urolithiasis, and none of these patients required urologic intervention. The rate of urologic intervention was significantly lower in those with normal US results (p<0.001) than in those with abnormal findings.

Conclusion

A normal renal sonogram predicts a low likelihood for urologic intervention within 90 days for adult ED patients with suspected renal colic.

Résumé

Introduction

II est souvent difficile de discerner, au service des urgences (SU), les patients qui sont susceptibles de subir une intervention rénale parmi ceux qui souffrent d’une urétérolithiase. L’étude visait à déterminer si l’obtention d’un échogramme rénal normal permettait de reconnaître les cas de colique né phré tique à faible risque, définis par l’absence de nécessité d’une intervention rénale dans les 90 jours suivant la première consultation au SU et par la possibilité d’une prise en charge conservatrice.

Méthode

II s’agit d’une étude de cohortes, prospective, menée au SU d’un centre hospitalier de soins tertiaires, sur une période de 20 mois, chez des adultes souffrant vraisemblablement d’une colique néphré tique. Une échographie ré nale (ER) a été effectuée au service d’imagerie diagnostique par des échographistes qualifiés, et les résultats ont été divisés en quatre groupes mutuellement exclusifs: normaux, évocateurs d’une urété rolithiase, révélateurs d’un calcul urétéral (visualisé ), et non liés à une lithiase urinaire. II y eu examen des dossiers médicaux électroniques afin de vérifier si des patients avaient subi une intervention rénale au cours des 90 jours suivant la consultation au SU.

Résultats

Sur 610 patients sé lectionnés, 341 (55.9%) ont subi une ER pour une colique néphrétique présumée. Parmi ceuxci, 105 (30.8%) ont obtenu des résultats normaux, et aucun d’entre eux n’a subi une intervention rénale au cours des 90 jours suivant la consultation au SU; chez 90 (26.4%) patients, l’ER a donné des ré sultats é vocateurs d’une uré té rolithiase, et 9 (10%) d’entre eux ont subi une intervention ré nale; chez 139 (40.8%) patients, l’ER a permis de visualiser un calcul uré té ral, et 34 (24.5%) d’entre eux ont subi une intervention ré nale; enfin, chez 7 (2.1%) patients, les ré sultats obtenus à l’ER n’étaient pas liés à une lithiase urinaire, et aucun d’entre eux n’a subi une intervention ré nale. Le taux d’intervention ré nale é tait significativement plus bas chez les patients ayant obtenu des résultats normaux à l’ER (p<0.001) que chez ceux ayant obtenu des résultats anormaux.

Conclusion

L’obtention d’un échogramme rénal normal permet de prévoir le faible risque d’intervention rénale dans les 90 jours suivant la consultation au SU, chez les adultes souffrant d’une colique néphrétique présumée.

Keywords

renal colicultrasonographyurolithiasis
Type
Original Research
Information
Canadian Journal of Emergency Medicine , Volume 17 , Issue 1 , January 2015 , pp. 38 - 45
Copyright
Copyright © Canadian Association of Emergency Physicians 2014 

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