Emergency Department Ultrasound in Renal Colic

Queen's University414 enrolled

Overview

Renal colic is a common (1300 visits per year at our institution) and painful condition caused by stones in the kidney and ureter, and can be mimicked by life threatening conditions such as a ruptured abdominal aortic aneurysm (AAA). This can create clinical uncertainty. Emergency department targeted ultrasound (EDTU) is performed by an emergency physician at the patient's bedside, and has been shown to be accurate, safe, and efficient. We have shown that EDTU can accurately identify hydronephrosis, which is a predictor of complications of kidney stones. A normal formal ultrasound (US) predicts an uncomplicated clinical course. We will assess the accuracy of EDTU for the diagnosis of hydronephrosis, and when normal, whether patients can be safely discharged.

Study Type

OBSERVATIONAL

Enrollment

414

Conditions

Renal Colic Hydronephrosis Abdominal Aortic Aneurysm

Interventions

EDTU

Eligibility

Sex: ALLMin age: 16 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age 16 - 65 years * Symptoms suggestive of renal colic * EDTU performed within one hour (before or after) of formal imaging * Imaging study arranged during this ED visit (includes next morning) Exclusion Criteria: * Hemodynamic instability (Pulse \> 120 or SBP \< 90 or requiring vasopressors) * Fever (\>38 degrees C) * Leukocytes and nitrites on dipstick urinalysis (evidence of urinary tract infection) * Pregnancy * Inmate * Renal transplant or single functioning kidney

Outcomes

Primary Outcomes

complications post-ED visit in patients with and without negative EDTU.

The frequency of complications by 30 days post-ED visit in patients with and without negative EDTU.

Time frame: 30 days

diagnostic accuracy for hydronephrosis

The accuracy of ED physicians in using EDTU to assess for hydronephrosis when compared to diagnostic imaging by CT or formal ultrasound.

Time frame: 1 hours

Secondary Outcomes

ED length of stay

estimates of potential time of ED stay saved if a clinical decision is made on the basis of an EDTU (rather than waiting for formal diagnostic imaging)

Time frame: 1 day

radiation dose

potential savings in radiation exposure from avoiding CT scanning

Time frame: 1 hour

accuracy in ruling out AAA

accuracy of ED physicians in using EDTU to assess aortic size (and rule out AAA) when compared to diagnostic imaging by CT or formal ultrasound will also be validated.