Article Text

other Versions

PDF
Imaging patients with renal colic: a comparative analysis of the impact of non-contrast helical computed tomography versus intravenous pyelography on the speed of patient processing in the Emergency Department
  1. M Quirke1,
  2. F Divilly2,
  3. P O'Kelly1,
  4. S Winder3,
  5. P Gilligan1
  1. 1Emergency Department, Beaumont Hospital, Dublin 9, Ireland
  2. 2Royal College of Surgeons in Ireland, Dublin 1, Ireland
  3. 3I.T. Department, Beaumont Hospital, Dublin 9, Ireland
  1. Correspondence to Dr Michael Quirke, c/o Dr P Gilligan, Consultant in Emergency Medicine, Beaumont Hospital, Beaumont Road, PO BOX 1297, Dublin 9, Ireland; mmmquirke{at}hotmail.com

Abstract

Introduction Non-contrast helical CT (NHCT) became the procedure of choice for investigating Emergency Department (ED) patients presenting with suspected renal colic at Beaumont Hospital, Dublin, in 2008. The impact of NHCT on waiting times and patient management was compared with intravenous pyelography (IVP).

Methods A retrospective, comparative cohort analysis of 95 patients who had IVP and 109 patients who had NHCT was performed. Length of ED stay from time of scan ordering to referral or discharge was analysed relative to time of day and scan result.

Results Patients having NHCT who attended between 00:00–08:00 h, had a twofold longer length of stay than those who had IVP between the same hours (median 7.07 h vs 3.03 h, p=0.0294). The length of ED stay for patients attending between 08:00 and 24:00 h was similar in both groups. The presence of urolithiasis did not impact on length of stay. A significant alternate/incidental diagnosis was reported in 28 patients having NHCT, of which 12 were cancerous growths.

Conclusion NHCT allows for the detection of incidental/alternate diagnoses that may not be otherwise detected in patients with renal colic. Compared to IVP, NHCT has not impacted positively on the speed of patient processing in the ED under study. For patients presenting after midnight, it is associated with over a twofold longer length of stay from the time of scan ordering to referral or discharge. This leads to prolonged patient stays in the ED, and as such contributes to overcrowding.

  • Helical CT/CTKUB
  • renal colic
  • intravenous pyelography/urography/IVP/IVU
  • emergency department/ED
  • length of stay
  • abdomen-non-trauma
  • renal
  • emergency care systems
  • emergency care systems
  • efficiency
  • imaging
  • resuscitation
  • effectiveness

Statistics from Altmetric.com

Footnotes

  • Competing interests None.

  • Ethics approval This study was approved by the chair of the ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Primary survey
    Geoff Hughes