Predicting intervention in renal colic patients after emergency department evaluation

Abstract

Objectives:There is no set of prospectively validated criteria to identify the emergency department (ED) patients with renal colic who are most likely to eventually have to undergo an intervention. This study prospectively assessed predictors of intervention in this patient population. Methods: This prospective cohort study included adult patients with renal colic who presented to 2 tertiary care hospital EDs. Patients had an 18-variable data form completed by an emergency physician and a radiological study to confirm urolithiasis. After discharge, patients were followed at 1 and 4 weeks to assess for intervention. The outcome criteria included the patient having had at least 1 of the following procedures performed: extracorporeal shockwave lithotripsy (ESWL), ureteroscopy, percutaneous nephrostomy or open surgery. Data were analyzed using appropriate univariate techniques, and those variables associated with intervention were combined using logistic regression analysis. Results: Over an 8-month period, 245 patients with confirmed urolithiasis were followed; 20% (95% confidence interval [CI] 15%-25%) eventually had a procedure to remove their calculi. Three variables were significantly correlated with having a procedure: i) size of calculus ≥ 6 mm (odds ratio [OR] 10.7, 95% CI 4.6-24.8), ii) location of calculus above mid-ureter (OR 6.9, 95% CI 3.0-15.9), and iii) Visual Analogue Scale score for pain at discharge from the ED ≥ 2 cm (OR 2.6, 95% CI 1.0-6.8). The area under receiver operating characteristic curve was 0.77 (95% C I 0.70-0.84) (p < 0.001). If all variables were present there was a 90% probability of the patient having an intervention performed within 4 weeks of discharge from the ED. Conversely, if none of the variables were present there was only a 4% probability of an intervention. Overall, the model had a sensitivity of 92% (95% CI 89%-96%) and a specificity of 63% (95% CI 57%-69%). Conclusions: This study has identified variables that could potentially be used to identify those renal colic patients who require an intervention after ED evaluation. Future studies will prospectively validate this model. RÉSUMÉObjectifs : Il n'existe pas d'ensemble de critères validés prospectivement pour identifier les patients reçus au département d'urgence pour une colique néphrétique qui sont les plus susceptibles EM ADVANCES • INNOVATIONS EN MU

Is computed tomography-defined obstruction a predictor of urological intervention in emergency department patients presenting with renal colic?

“…14 However, most importantly, we found that obstruction was not an independent criterion for intervention, which is inconsistent with previous studies reporting an association between intervention and degree of hydronephrosis. [11][12][13] Taylor et al, for example, recently reported a + likelihood ratio (LR) of 1.45 for mild hydronephrosis and 3.05 for moderate to severe hydronephrosis.…”

Emergency Department Imaging Modality Effect on Surgical Management of Nephrolithiasis: A Multicenter, Randomized Clinical Trial

“…This is in contrast to survey data reporting a preference for ureteroscopy over stent placement previously suggested by survey results. 8 In the nonemergent context URS and SWL were the most commonly performed urological procedures, which confirms previous reports. 8,10 Our study was unique as it followed patients prospectively at multiple centers from presentation in the ED and examined how initial imaging modality affected treatment pattern.…”

“…8 In the nonemergent context URS and SWL were the most commonly performed urological procedures, which confirms previous reports. 8,10 Our study was unique as it followed patients prospectively at multiple centers from presentation in the ED and examined how initial imaging modality affected treatment pattern. We found that consultation rates, frequency of intervention and types of procedures did not vary by whether the patient had 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 ...…”

“…Previous single center studies have shown that as many as 37% to 86% of patients diagnosed with stones receive a consultation with a urologist 6,7 and 15% to 20% require a procedure for their stone. 6,8 With the increasing use of US as a first line imaging option in the acute setting, this change in practice pattern might alter subsequent evaluation or delay definitive intervention by the urologist.…”

The effect of shockwave lithotripsy on blood pressure, patients’ tolerance to pain and perirenal hematoma in renal stone patients

“…[11,12] It can be assessed according to the visual analog scale (VAS) which is a patient self-report on a scale of 0-10. [13] It is usually treated on outpatient basis by the administration of analgesics in the form of NSAID or narcotics, and only few patients require hospitalization. [9,14,15] Hypertension is another complication of SWL.…”