Accuracy of Reduced-Dose Computed Tomography for Ureteral Stones in Emergency Department Patients

Moore, Christopher L.; Daniels, Brock; Ghita, Monica; Gunabushanam, Gowthaman; Luty, Seth; Singh, Dinesh; Gross, Cary P.

doi:10.1016/j.annemergmed.2014.09.008

Cited by 39 publications

(46 citation statements)

References 56 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In these cases, we made attempts to communicate with the publishing author to request access to the TP/TN/FP/FN data per patient. This resulted in 12 articles for inclusion in the review [8, 16, 25-34]. Flow chart shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…Studies were separated into LD and ULD CT groups, based on the mean radiation dose (mSv). Of these, 4 studies assessed LD CT KUB, including a total of 475 patients [25-28] and 8 studies looked at ULD CT KUB including a total of 1,054 patients [8, 16, 29-34]. Also, 2 of the studies in this category reported TP/TN/FP/FN data from multiple scan reviewers.…”

Section: Resultsmentioning

confidence: 99%

“…The index test was LD CT KUB in 4 papers [25-28] and ULD CT KUB in 8 papers [8, 16, 29-34]. There was variation in the reference standards used, with 7 papers using standard dose CT KUB as the reference standard [8, 16, 25, 27, 30, 32, 34].…”

Section: Resultsmentioning

confidence: 99%

“…There was variation in the reference standards used, with 7 papers using standard dose CT KUB as the reference standard [8, 16, 25, 27, 30, 32, 34]. Of the remaining studies, 1 used CT intravenous urography as their reference standard [26] and 3 used physical stone demonstration either during endoscopic procedure or collection following spontaneous passage [28, 29, 31].…”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Diagnostic Accuracy of Low and Ultra-Low Dose CT for Identification of Urinary Tract Stones: A Systematic Review

Rodger¹,

Roditi²,

Aboumarzouk³

2018

Urol Int

View full text Add to dashboard Cite

Background: Non-contrast computed tomography of the kidneys, ureters, and bladder (CT KUB) is the investigation of choice for renal colic; however, radiation exposure can be a concern. Aims: The study aimed to investigate the diagnostic accuracy of low dose (LD) and ultra-low dose (ULD) CT of the urinary tract for detection of urinary tract stones in patients with renal colic. Methods: A Cochrane style systematic review of the literature from 1995 to 2017 was carried out. Literature search and data extraction were conducted by 2 reviewers. Specificity and sensitivity values were calculated for LD (<3.5 mean radiation dose [mSv]) and ULD (<1.9 mSv) CT separately. Results: A total of 12 studies were included following screening. A total of 1,529 patients were included in the review (475 in the LD group and 1,054 in the ULD group). Using standard dose CT KUB as the reference standard, the sensitivity of LD CT KUB ranged from 90 to 98% and specificity from 88 to 100%. The sensitivity of ULD CT KUB ranged from 72 to 99% and the specificity ranged from 86 to 100%. The diagnostic accuracy for LD CT was 94.3% and for ULD CT was 95.5%. Conclusions: LD and ULD CT KUB provide effective methods of identifying urinary tract stones. High diagnostic accuracy, sensitivity, and specificity are maintained despite significant radiation dose reduction in comparison to standard dose CT.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Diagnostic Accuracy of Low and Ultra-Low Dose CT for Identification of Urinary Tract Stones: A Systematic Review

Rodger¹,

Roditi²,

Aboumarzouk³

2018

Urol Int

View full text Add to dashboard Cite

show abstract

“…23 Reduced-dose CT is recommended by the American College of Radiologists when symptomatic stone is suspected. 24 However, less than 2% of CT scans for renal colic in the United States are conducted with a reduceddose protocol.…”

Section: Discussionmentioning

confidence: 99%

STONE PLUS: Evaluation of Emergency Department Patients With Suspected Renal Colic, Using a Clinical Prediction Tool Combined With Point-of-Care Limited Ultrasonography

Daniels

Gross

Molinaro

et al. 2016

Annals of Emergency Medicine

Self Cite

View full text Add to dashboard Cite

Study objective-We determine whether renal point-of-care limited ultrasonography (PLUS) used in conjunction with the Sex, Timing, Origin, Nausea, Erythrocytes (STONE) clinical prediction score can aid identification of emergency department (ED) patients with uncomplicated ureteral stone or need for urologic intervention.Methods-This was a prospective observational study of adult ED patients undergoing computed tomography (CT) scan for suspected ureteral stone. The previously validated STONE score classifies patients into risk categories of low (≈10%), moderate (≈50%), or high (≈90%) for symptomatic stone. Renal PLUS assessed for presence of hydronephrosis before CT scanning. The primary outcomes of symptomatic ureteral stone or acutely important alternative finding were abstracted from CT reports. The secondary outcome, urologic intervention, was assessed by 90-day follow-up interview and record review.Results-Of 835 enrolled patients, ureteral stone was identified in 53%, whereas 6.5% had an acutely important alternative finding on CT. Renal PLUS modestly increased sensitivity for symptomatic stone among low and moderate STONE score categories. Moderate or greater hydronephrosis improved specificity from 67% (62% to 72%) to 98% (93% to 99%) and 42% (37% to 47%) to 92% (86% to 95%) in low-and moderate-risk patients, with likelihood ratios of 22 (95% CI, 4.2-111) and 4.9 (95% CI, 2.9-8.3), respectively. Test characteristics among high-risk patients were unchanged by renal PLUS. For urologic intervention, any hydronephrosis was 66% sensitive (57% to 74%), whereas moderate or greater hydronephrosis was 86% specific overall * Corresponding Author. brockdaniels@gmail.com. Author contributions: BD and CLM conceived the study. CPG, DS, and CLM and obtained research funding. SL and CLM supervised the conduct of the trial and data collection. SL participated in recruitment of patients. AM, SL, RJ, and CLM managed the data, including quality control. CPG and AM provided statistical advice. CPG, AM, and DS provided advisement on study design and methodology. BD, AM, RJ, and CLM analyzed the data. BD drafted the article and all authors contributed substantially to its revision. BD takes responsibility for the paper as a whole.Presented as an abstract at the Society for Academic Emergency Medicine annual meeting, May 2014, Dallas, TX.Clinical trial registration number: NCT01352676 HHS Public Access

show abstract

A systematic review and meta‐analysis of clinical signs, symptoms, and imaging findings in patients with suspected renal colic

et al. 2022

View full text Add to dashboard Cite

Study Objective The objective of this study was to conduct a systematic review and meta‐analysis of the diagnostic accuracy of the clinical signs, symptoms, laboratory investigations, and imaging modalities commonly used in patients with clinically suspected renal colic. Methods We conducted this systematic review and meta‐analysis according to an a priori, registered protocol (PROSPERO CRD42017055153). A literature search was performed using MEDLINE and EMBASE from inception to July 2, 2020. We assessed the risk of bias using Quality Assessment of Diagnostic Accuracy Studies–2, calculated likelihood ratios (LRs), and applied a random‐effects model for meta‐analysis. Results Among 7641 references screened, 76 were included in the systematic review and 53 were included in the meta‐analyis. The overall pooled prevalence for ureteral stones was 63% (95% confidence interval [CI], 58%–67%). No individual demographic feature, symptom, or sign when present had an LR+ ≥2.0 for identifying ureterolithiasis. A (Sex, Timing and Origin of pain, race, presence or absence of Nausea, and Erythrocytes) STONE score ≥10 increased (sensitivity 0.49, specificity 0.91, LR 5.3 [95% CI, 4.1–6.7]) and a STONE score <6 reduced the likelihood of ureteral stones (sensitivity 0.94, specificity 0.43, LR 0.15 [95% CI, 0.10–0.22]). Standard‐dose (sensitivity 0.96, specificity 0.94, LR+ 16 [95% CI, 11–23], LR− 0.05 [95% CI, 0.03–0.07]) and low‐dose computed tomography (CT) scanning (sensitivity 0.93, specificity 0.94, LR+ 17 [95% CI, 8.8–31], LR− 0.08 [95% CI, 0.03–0.19]) were the most useful imaging techniques for identifying patients with or without ureteral stones. Conclusions Individual signs, symptoms, or the presence of microscopic hematuria do not substantially impact the likelihood of ureteral stones in patients with clinically suspected renal colic. The STONE score at high and low thresholds and a modified STONE score at a high threshold may sufficiently guide physicians’ decisions to obtain imaging. Low‐dose, non‐contrast CT imaging provides superior diagnostic accuracy compared with all other imaging index tests that are comparable with standard CT imaging. Limitations of the evidence include methodological shortcomings and considerable heterogeneity of the included studies.

show abstract

Accuracy of Reduced-Dose Computed Tomography for Ureteral Stones in Emergency Department Patients

Cited by 39 publications

References 56 publications

Diagnostic Accuracy of Low and Ultra-Low Dose CT for Identification of Urinary Tract Stones: A Systematic Review

Diagnostic Accuracy of Low and Ultra-Low Dose CT for Identification of Urinary Tract Stones: A Systematic Review

STONE PLUS: Evaluation of Emergency Department Patients With Suspected Renal Colic, Using a Clinical Prediction Tool Combined With Point-of-Care Limited Ultrasonography

A systematic review and meta‐analysis of clinical signs, symptoms, and imaging findings in patients with suspected renal colic

Contact Info

Product

Resources

About