Ultrasonography versus Computed Tomography for Suspected Nephrolithiasis

Smith‐Bindman, Rebecca; Aubin, Chandra; Bailitz, John; Bengiamin, Rimon; Camargo, Carlos A.; Corbo, Jill; Dean, Anthony J.; Goldstein, Ruth B.; Griffey, Richard T.; Jay, Gregory D.; Kang, Tarina L.; Kriesel, Dana R.; J., O.; Mallin, Mike; Manson, William C.; Melnikow, Joy; Miglioretti, Diana L.; Miller, Sara; Mills, Lisa D.; Miner, J. R.; Moghadassi, Michelle; Noble, Vicki E.; Press, Gregory M.; Stoller, Marshall L.; Valencia, Victoria; Wang, J.; Wang, R. C.; Cummings, Steven R.

doi:10.1056/nejmoa1404446

Cited by 538 publications

(402 citation statements)

References 15 publications

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“…8,11,[17][18][19] A recent multicenter, randomized trial of ED patients with suspected renal colic demonstrated the noninferiority of ultrasonography, including point-of-care ultrasonography, compared with CT with respect to diagnosis of symptomatic stones and identification of significant alternative diagnoses. 20 The study concluded that the "results do not suggest that patients should undergo only ultrasonography imaging, but rather that ultrasonography should be used as the initial diagnostic imaging test, with further imaging performed at the discretion of the physician on the basis of clinical judgment." Nearly half (40%) of the patients in the point-of-care ultrasonography group received a regular-dose CT scan.…”

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

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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

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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

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“…Because many individuals with USD will undergo multiple imaging procedures, radiation exposure is concerning. For this reason, a recent randomized trial examined clinical outcomes when renal ultrasound was used as the initial imaging modality for patients with suspected USD who were stable and without clinical evidence of sepsis (63). Initial renal ultrasound reduced average radiation dose by nearly 50% without any increase in adverse events or alternative high-risk diagnoses versus CT.…”

Section: Treatment and Prevention Strategies Initial Evaluationmentioning

confidence: 99%

Urinary Stone Disease: Advancing Knowledge, Patient Care, and Population Health

Scales

Tasian

Schwaderer

et al. 2016

CJASN

137

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Expanding epidemiologic and physiologic data suggest that urinary stone disease is best conceptualized as a chronic metabolic condition punctuated by symptomatic, preventable stone events. These acute events herald substantial future chronic morbidity, including decreased bone mineral density, cardiovascular disease, and CKD. Urinary stone disease imposes a large and growing public health burden. In the United States, 1 in 11 individuals will experience a urinary stone in their lifetime. Given this high incidence and prevalence, urinary stone disease is one of the most expensive urologic conditions, with health care charges exceeding $10 billion annually. Patient care focuses on management of symptomatic stones rather than prevention; after three decades of innovation, procedural interventions are almost exclusively minimally invasive or noninvasive, and mortality is rare. Despite these advances, the prevalence of stone disease has nearly doubled over the past 15 years, likely secondary to dietary and health trends. The NIDDK recently convened a symposium to assess knowledge and treatment gaps to inform future urinary stone disease research. Reducing the public health burden of urinary stone disease will require key advances in understanding environmental, genetic, and other individual disease determinants; improving secondary prevention; and optimal population health strategies in an increasingly cost-conscious care environment.

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“…The recent work by Smith-Bindman et al [1] may influence future guidelines of emergency department practitioners, radiology department practitioners, and, maybe, urologists.…”

Section: Reference Standardmentioning

confidence: 99%

Who wants to go further has to know the past

Luyckx

2014

World J Urol

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EDITORIAL Who wants to go further has to know the pastRecently, Moore et al.[2] built the STONE score, a 13-point scale including risk factors for uncomplicated ureteral stone. It encloses sex risk factors, origin, duration of pain to presentation, nausea, and haematuria.This score, built upon a large series, confirms the relevance of clinical examination (patient history and physical examination) when evaluating the risk of nephrolithiasis in order to choose the proper imaging method.Has the «likelihood of kidney stones» been calculated upon such a score or was it a subjective score written by the practitionists?The «likelihood of kidney stones» was of 50 % in 32.1 to 37.1 % of the patients over the three groups.It may be explained by the poor reliability of the symptoms used to include patients.Furthermore, this may explain the unusual description of the population, far from the nephrolithiasis populations (as an example a M:F sex ratio of 1:1 in this study, 2:1 in the nephrolithiasis populations [2]).

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Ultrasonography versus Computed Tomography for Suspected Nephrolithiasis

Cited by 538 publications

References 15 publications

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

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

Urinary Stone Disease: Advancing Knowledge, Patient Care, and Population Health

Who wants to go further has to know the past

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