Objectives: to determine the accuracy of renal point of care ultrasound (POCUS) performed by emergency physicians in detecting hydronephrosis in patients with renal colic. Methods: We conducted a prospective cross-sectional diagnostic study at Sultan Qaboos University Hospital, emergency department (ED), from February 2017 to October 2018. All adult patients with suspected renal colic and who can give informed consent were included. The emergency physicians perform POCUS on both kidneys and graded hydronephrosis as none, mild, moderate, or severe cases. We compared POCUS grade to non-contrast computed tomography (NCCT) grade. Results: Three hundred and three participants were enrolled in the analysis. Most of the study population are adult males, 247 (81.5%), and the mean age is 39 years. Among the samples, 71.2% of patients had a degree of hydronephrosis based on CT findings. Ultrasound performed by emergency physicians had a sensitivity of 75.8% (95% CI: 69.5‒81.4), the specificity of 55.2% (95% CI: 44.1‒65.8), the positive likelihood ratio of 1.69 (95% CI: 1.32‒2.16), and negative likelihood ratio 0.43 (95% CI: 0.32‒0.59) for hydronephrosis using CT as the criterion standard. Conclusions: When evaluating patients with suspected renal colic, a bedside renal POCUS performed by emergency physicians (EP) has a moderate sensitivity to detect hydronephrosis and grade its severity. It should be utilized in the ED to screen patients for hydronephrosis. More training is required to improve the test's accuracy, as this might help as a screening tool in ED.Keywords: Hematuria; Hydronephrosis; Nephrolithiasis; Point-of-care testing; Renal colic; Ultrasonography.

Objective The EZ-IO intraosseous (IO) needle is available in 2 needle sizes for children based on the patient weight. To date, there is no published evidence validating the use of weight-based scaling in children. We hypothesized that pretibial subcutaneous tissue thickness (PSTT) does not correspond with patient weight but rather with age and body mass index (BMI). Our objective was to describe the relationship of a patient's PSTT to their weight, age, and BMI in children less than 40 kg. Method One hundred patients who weighed less than 40 kg were recruited prospectively from October 2013 to April 2015 at a tertiary care pediatric emergency department. All sonographic assessments were performed by 1 of 2 emergency physicians certified in point-of-care ultrasound. A single sonographic image was taken over the proximal tibia corresponding to the site of IO insertion. In patients where both sonographers performed independent measurements, a Pearson correlation coefficient was determined. Univariate linear regression was performed to determine the relationship between age, weight, and BMI with PSTT. Results One hundred participants were recruited and ranged in age from 10 days to 14 years (mean [SD], 5.01 [3.14] years). Fifty-seven percent of participants were male. Patients' weights ranged from 3.5 to 39.3 kg (mean [SD], 21.42 [9.12] kg), and BMI ranged from 12.1 to 45.0 kg/m2 (mean [SD], 17.31 [4.00]). The mean (SD) PSTT across participants was 0.68 (0.2) cm. The intraclass correlation coefficient for agreement between the 2 sonographers was moderate (intraclass correlation coefficient, 0.602 [confidence interval, 0.385–0.757]). There were significant positive correlations between BMI and PSTT (r = 0.562, P = <0.001) as well as weight and PSTT (r = 0.293, P < 0.003). There was a weak correlation between age and PSTT (0.065, P = 0.521). Conclusions Pretibial subcutaneous tissue thickness correlates most strongly with BMI, followed by weight, and weakly with age. Our findings suggest that current IO needle length recommendations should be based on BMI rather than weight. This would suggest that clinicians need to be aware that young patients in particular with large BMIs may pose problems with current weight-based needle length recommendations.

No abstract