Can plain film radiography improve the emergency department detection of clinically important urinary stones? - 30/11/21
, Ian Wishart, MD b , Torey Lau, MD c , Abir Islam, BSc d , Katie Gourlay, BSc e , Frank X. Scheuermeyer, MD, MHSc fAbstract |
Objective |
Physicians frequently use ultrasound to assess hydronephrosis in patients with suspected renal colic, but ultrasound has limited diagnostic sensitivity and rarely clarifies stone size or location. Consequently, up to 80% of emergency department (ED) renal colic patients undergo confirmatory CT imaging. Our goal was to estimate x-ray sensitivity for urinary stones and determine whether x-ray substantially improves stone detection (sensitivity) compared to hydronephrosis assessment alone.
Methods |
We reviewed imaging reports from all renal colic patients who underwent x-ray and CT at four EDs. For each patient, we documented stone size, location and hydronephrosis severity on CT and whether stones were identified on x-ray. We considered moderate and severe hydronephrosis (MS-Hydro) as significant positive findings, then calculated the sensitivity (detection rate) of MS-Hydro and x-ray for large stones ≥5 mm and for stones likely to require intervention (all ureteral stones >7 mm and proximal or middle stones >5 mm). We then tested a diagnostic algorithm adding x-ray to hydronephrosis assessment.
Results |
Among 1026 patients with 1527 stones, MS-Hydro sensitivity was 39% for large stones and 60% for interventional stones. X-ray sensitivity was 46% for large stones and 52% for interventional stones. Adding x-ray to hydronephrosis assessment increased sensitivity in all stone categories, specifically from 39% to 68% for large stones (gain = 29%; 95%CI, 23% to 35%) and from 60% to 82% for interventional stones (gain = 22%; 95%CI, 13% to 30%). Because CT and ultrasound show strong agreement for MS-Hydro identification, physicians who depend on ultrasound-based hydronephrosis assessment could achieve similar gains by adding x-ray.
Conclusions |
Adding x-ray to hydronephrosis assessment substantially improves diagnostic sensitivity, enabling the detection of nearly 70% of large stones and over 80% of interventional stones. This level of sensitivity may be sufficient to reassure physicians about a renal colic diagnosis without CT imaging for many patients.
Le texte complet de cet article est disponible en PDF.Highlights |
• | X-ray and ultrasound are rapid, inexpensive, low-radiation tests for urinary stones. |
• | Hydronephrosis is more sensitive for interventional stones and ureteral stones. |
• | X-ray is more sensitive for large stones and renal stones. |
• | The combination detects 70% of large stones and over 80% of interventional stones. |
• | Negative results for both tests suggest a low-risk stone not requiring CT imaging. |
Keywords : Nephrolithiasis, Renal colic, Imaging, Diagnosis
Plan
| ☆ | Renal colic x-ray. |
Vol 50
P. 449-454 - décembre 2021 Retour au numéro
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