Imaging in Suspected Renal Colic: Systematic Review of the Literature and Multispecialty Consensus - 23/08/19
, Christopher R. Carpenter, MD, MSc b, Marta E. Heilbrun, MD c, Kevin Klauer, DO, EJD d, e, Amy Krambeck, MD c, Courtney Moreno, MD c, Erick M. Remer, MD f, Charles Scales, MD g, Melissa M. Shaw, BS a, Kevan M. Sternberg, MD hAbstract |
Study objective |
Renal colic is common and computed tomography (CT) is frequently used when the diagnosis of kidney stone is suspected. CT is accurate but exposes patients to ionizing radiation and has not been shown to alter either interventional approaches or hospital admission rates. This multiorganizational transdisciplinary collaboration seeks evidence-based, multispecialty consensus on optimal imaging across different clinical scenarios in patients with suspected renal colic in the acute setting.
Methods |
In conjunction with the American College of Emergency Physicians (ACEP) Emergency Quality Network, we formed a 9-member panel with 3 physician representatives each from ACEP, the American College of Radiology, and the American Urology Association. A systematic literature review was used as the basis for a 3-step modified Delphi process to seek consensus on optimal imaging in 29 specific clinical scenarios.
Results |
From an initial search yielding 6,337 records, there were 232 relevant articles of acceptable evidence quality to guide the literature summary. At the completion of the Delphi process consensus, out of the 29 scenarios agreement was rated as perfect in 15 (52%), excellent in 8 (28%), good in 3 (10%), and moderate in 3 (10%). There were no scenarios in which at least moderate consensus was not reached. CT was recommended in 7 scenarios (24%), with ultrasonography in 9 (31%) and no further imaging needed in 12 (45%).
Conclusion |
Evidence and multispecialty consensus support ultrasonography or no further imaging in specific clinical scenarios, with reduced-radiation-dose CT to be used when CT is needed for patients with suspected renal colic.
Le texte complet de cet article est disponible en PDF.Plan
| Please see page 392 for the Editor’s Capsule Summary of this article. |
|
| Supervising editor: Gregory W. Hendey, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
|
| Author contributions: CLM conceived the study. AL, CLM, EKR, KK, and MS drafted the article. All authors designed the analysis methods and performed data collection. All authors interpreted and analyzed the data, edited the article, and approved the final article for publication. CLM takes responsibility for the paper as a whole. |
|
| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
|
| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). This work was supported by the Agency for Healthcare Research and Quality grant R18HS023778. Dr. Moore declares grant funds from the Agency for Healthcare Research and Quality and Philips Healthcare, nonfinancial support from BK Medical and GE Healthcare, and is a colsultant for American College of Emergency Physicians. Dr. Krambeck is a consultant for Lumenis and Boston Scientific. Dr. Scales declares grant funds from NIDDK and Allena Pharmaceuticals. Ms. Shaw declares grant funds from the Agency for Healthcare Research and Quality. Dr. Sternberg is a consultant for Bard Endourology. |
Vol 74 - N° 3
P. 391-399 - septembre 2019 Retour au numéro
Article précédent
- The Utility and Survivorship of Peripheral Intravenous Catheters Inserted in the Emergency Department
- Hamid Shokoohi, Keith S. Boniface, Paige Kulie, Andrew Long, Melissa McCarthy
- What Is the Diagnostic Accuracy of Point-of-Care Ultrasonography in Patients With Suspected Blunt Thoracoabdominal Trauma?
- Brit Long, Michael D. April
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?