Bedside Ultrasound and the Assessment of Renal Colic
Bedside Ultrasound and the Assessment of Renal Colic
Renal colic is a common emergency department (ED) presentation. The use of CT in the diagnosis of renal colic has increased over the past two decades and is now the most common imaging modality used in many institutions. However, with growing concerns about cumulative radiation exposure, increasing healthcare costs and patient flow in EDs, alternative approaches may need to be considered. Point-of-care ultrasound may offer a radiation-free, rapid and cost-effective alternative. The authors reviewed the literature and synthesised some of the data comparing point-of-care ultrasound with CT scanning as well as some of the evidence for how it might be incorporated into a renal colic management strategy. It is concluded that there is enough evidence to define a rational algorithm for renal colic management. A prospectively validated algorithm would greatly assist primary care and emergency practitioners while reducing costs and radiation dose.
Imaging is frequently used to direct the diagnosis and management of renal colic. Choices for assessing the urinary tract include kidney–ureter–bladder x-ray films (KUB), intravenous pyelourethrography (IVPU), ultrasound and CT. Over the past 20 years the use of imaging has changed considerably, with IVPU use declining dramatically in the USA and CT use increasing. CT is now the most common imaging modality, however, ultrasound remains an important diagnostic tool and is the imaging modality of choice in young patients and pregnant women.
More recently, 'point-of-care' clinician-performed bedside ultrasound (BUS) has emerged as a diagnostic imaging option when assessing emergency department (ED) patients, including those presenting with flank pain. With growing concern over CT-related radiation exposure, increasing ED patient volumes and healthcare cost-consciousness, there is growing interest in the potential of BUS to provide meaningful clinical information in a rapid and cost-effective manner for renal colic management.
We will look at some of the published evidence examining the use of BUS in the clinical assessment of renal colic and nephrolithiasis (see online supplementary material).
Note: Where summary statistics have been reported we have used the authors' own calculations. Where we have made calculations from their data, we have denoted these derived statistics with an asterisk in the text and tables. All confidence intervals (CI) are 95% confidence intervals calculated with Wilson's method.
Abstract and Introduction
Abstract
Renal colic is a common emergency department (ED) presentation. The use of CT in the diagnosis of renal colic has increased over the past two decades and is now the most common imaging modality used in many institutions. However, with growing concerns about cumulative radiation exposure, increasing healthcare costs and patient flow in EDs, alternative approaches may need to be considered. Point-of-care ultrasound may offer a radiation-free, rapid and cost-effective alternative. The authors reviewed the literature and synthesised some of the data comparing point-of-care ultrasound with CT scanning as well as some of the evidence for how it might be incorporated into a renal colic management strategy. It is concluded that there is enough evidence to define a rational algorithm for renal colic management. A prospectively validated algorithm would greatly assist primary care and emergency practitioners while reducing costs and radiation dose.
Introduction
Imaging is frequently used to direct the diagnosis and management of renal colic. Choices for assessing the urinary tract include kidney–ureter–bladder x-ray films (KUB), intravenous pyelourethrography (IVPU), ultrasound and CT. Over the past 20 years the use of imaging has changed considerably, with IVPU use declining dramatically in the USA and CT use increasing. CT is now the most common imaging modality, however, ultrasound remains an important diagnostic tool and is the imaging modality of choice in young patients and pregnant women.
More recently, 'point-of-care' clinician-performed bedside ultrasound (BUS) has emerged as a diagnostic imaging option when assessing emergency department (ED) patients, including those presenting with flank pain. With growing concern over CT-related radiation exposure, increasing ED patient volumes and healthcare cost-consciousness, there is growing interest in the potential of BUS to provide meaningful clinical information in a rapid and cost-effective manner for renal colic management.
We will look at some of the published evidence examining the use of BUS in the clinical assessment of renal colic and nephrolithiasis (see online supplementary material).
Note: Where summary statistics have been reported we have used the authors' own calculations. Where we have made calculations from their data, we have denoted these derived statistics with an asterisk in the text and tables. All confidence intervals (CI) are 95% confidence intervals calculated with Wilson's method.
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