From Ruling Out to Ruling In: Putting <scp>POCUS</scp> in Focus

Venkatesh, Arjun K.; Scales, Charles D.; Heilbrun, Marta E.

doi:10.1111/acem.13389

Cited by 4 publications

(3 citation statements)

References 16 publications

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“…While the superior accuracy of CT is not debatable, concerns regarding lifetime radiation exposure have led many to propose alternative diagnostic algorithms [11][12][13]. Many patients with kidney stones undergo two or more CT scans during the management of each unique episode of colic; fluoroscopy is often used during the treatment of stones; and recurrent episodes of colic, which occur in > 50% of patients, result in repeat imaging [14,15].…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

Feasibility and efficacy of a decision aid for emergency department patients with suspected ureterolithiasis: protocol for an adaptive randomized controlled trial

Schoenfeld

Poronsky

Westafer

et al. 2021

Trials

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Background Approximately 2 million patients present to emergency departments in the USA annually with signs and symptoms of ureterolithiasis (or renal colic, the pain from an obstructing kidney stone). Both ultrasound and CT scan can be used for diagnosis, but the vast majority of patients receive a CT scan. Diagnostic pathways utilizing ultrasound have been shown to decrease radiation exposure to patients but are potentially less accurate. Because of these and other trade-offs, this decision has been proposed as appropriate for Shared Decision-Making (SDM), where clinicians and patients discuss clinical options and their consequences and arrive at a decision together. We developed a decision aid to facilitate SDM in this scenario. The objective of this study is to determine the effects of this decision aid, as compared to usual care, on patient knowledge, radiation exposure, engagement, safety, and healthcare utilization. Methods This is the protocol for an adaptive randomized controlled trial to determine the effects of the intervention—a decision aid (“Kidney Stone Choice”)—on patient-centered outcomes, compared with usual care. Patients age 18–55 presenting to the emergency department with signs and symptoms consistent with acute uncomplicated ureterolithiasis will be consecutively enrolled and randomized. Participants will be blinded to group allocation. We will collect outcomes related to patient knowledge, radiation exposure, trust in physician, safety, and downstream healthcare utilization. Discussion We hypothesize that this study will demonstrate that “Kidney Stone Choice,” the decision aid created for this scenario, improves patient knowledge and decreases exposure to ionizing radiation. The adaptive design of this study will allow us to identify issues with fidelity and feasibility and subsequently evaluate the intervention for efficacy. Trial registration ClinicalTrials.gov NCT04234035. Registered on 21 January 2020 – Retrospectively Registered

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Section: Background and Rationale {6a}mentioning

confidence: 99%

Feasibility and efficacy of a decision aid for emergency department patients with suspected ureterolithiasis: protocol for an adaptive randomized controlled trial

Schoenfeld

Poronsky

Westafer

et al. 2021

Trials

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“…2 Ultrasound, both ED point-of-care ultrasound (POCUS) and radiology performed, is considered an acceptable and safe alternative to CT despite lower accuracy. 3 Because the decision between these 2 diagnostic modalities involves trade-offs, this clinical situation has been identified by the emergency medicine community as appropriate for shared decision making (SDM). 4,5 However, to participate in SDM in this context, clinicians need to know evidencebased answers to patient-centered questions regarding the risks and benefits of obtaining versus delaying a CT.…”

Section: Introductionmentioning

confidence: 99%

What are the clinical effects of the different emergency department imaging options for suspected renal colic? A scoping review

et al. 2021

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“…Controversy exists within emergency medicine regarding the need for routine CT in patients with suspected renal colic. 6,7,8,9 Urology guidelines suggest using CT to confirm the diagnosis of stone and to evaluate anatomic characteristics before a stone removal procedure; however, a patient’s likelihood of needing a procedure is generally unknown before the CT, creating a paradox for emergency practitioners. 10 Patients have also expressed that understanding the risk of radiation exposure and the likelihood of needing a urologic procedure is important to them.…”

Section: Introductionmentioning

confidence: 99%

Association of Patient and Visit Characteristics With Rate and Timing of Urologic Procedures for Patients Discharged From the Emergency Department With Renal Colic

et al. 2019

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From Ruling Out to Ruling In: Putting POCUS in Focus

Cited by 4 publications

References 16 publications

Feasibility and efficacy of a decision aid for emergency department patients with suspected ureterolithiasis: protocol for an adaptive randomized controlled trial

Feasibility and efficacy of a decision aid for emergency department patients with suspected ureterolithiasis: protocol for an adaptive randomized controlled trial

What are the clinical effects of the different emergency department imaging options for suspected renal colic? A scoping review

Association of Patient and Visit Characteristics With Rate and Timing of Urologic Procedures for Patients Discharged From the Emergency Department With Renal Colic

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