Introduction of a new imaging guideline for suspected renal colic in the ED reduces CT urography utilisation

Abstract

We found that use of CTU for renal colic was significantly reduced by introduction of a guideline promoting ultrasound and encouraging selective CTU. Although intervention rates were similar between the two sites, further prospective study is needed to ensure other patient-centred outcomes do not differ.

Deliberate clinical inertia: Using meta‐cognition to improve decision‐making

“…This ‘normalisation of deviance’ could contribute to the over‐testing and over‐treatment that has been described over the last 20 years. For example, in the last decade, the proportion of patients with suspected renal colic who undergo CT scans of the kidneys, ureters and bladder has progressively increased from 25% to 75% . If this increase had occurred rapidly, clinicians would interpret it as an unwarranted variation from standard practice, but as it has occurred gradually it has become accepted as not only normal but as standard practice.…”

‘What the hell is water?’ How to use deliberate clinical inertia in common emergency department situations

“…26,27 Red flags for renal colic include: suspected renal tract infection, renal impairment, transplanted or single kidney, pain unresponsive to analgesia and age over 50 years. 14 The acronym FLAG (Fever, Loss of renal function, Analgesia and Age >50 years) is helpful. A recent quasi-experimental study combining POCUS and a guideline incorporating 'red flags' reduced CTU ordering by an absolute amount of 18% of patients attending with suspected renal colic at the test site.…”

“…A recent quasi-experimental study combining POCUS and a guideline incorporating 'red flags' reduced CTU ordering by an absolute amount of 18% of patients attending with suspected renal colic at the test site. 14 In patients with suspected renal colic, deliberate clinical inertia should be employed to safely reduce test ordering. For patients with typical symptoms of renal colic and the absence of red flags, clinicians can choose to engage the patients with shared decision-making regarding CTU.…”

“…‘Red flags’ have been used to guide the need for diagnostic imaging in non‐traumatic back pain for decades although their value has been recently questioned . Red flags for renal colic include: suspected renal tract infection, renal impairment, transplanted or single kidney, pain unresponsive to analgesia and age over 50 years . The acronym FLAG (Fever, Loss of renal function, Analgesia and Age >50 years) is helpful.…”

“…The acronym FLAG (Fever, Loss of renal function, Analgesia and Age >50 years) is helpful. A recent quasi‐experimental study combining POCUS and a guideline incorporating ‘red flags’ reduced CTU ordering by an absolute amount of 18% of patients attending with suspected renal colic at the test site …”