Brief ReportBedside renal ultrasound in the evaluation of suspected ureterolithiasis☆
Introduction
Non-contrast computed tomography (CT) scanning of the abdomen and pelvis is accepted as the most accurate diagnostic modality for ureterolithiasis in emergency department (ED) patients [1], [2], [3]. However, CT is time-consuming, costly, and exposes patients to radiation. Bedside renal ultrasound is relatively sensitive and specific for unilateral hydronephrosis, and may be of diagnostic value to emergency physicians evaluating patients with possible ureterolithiasis [4], [5], [6]. Although renal ultrasound is a core component of training in emergency ultrasound [7], emergency physicians do not use this modality as commonly as other applications such as the Focused Assessment with Sonography in Trauma, aortic, and early pregnancy examinations [8]. The reasons for this relative underutilization of ultrasound are unclear but may be due to limited published data on how bedside renal ultrasound might be incorporated into medical decision making. Presently, when sonography is employed in patients with flank pain, the impact of sonographic findings on emergency physicians' impression of disease likelihood is unknown. The purpose of this study was to determine whether ultrasound changes a physician's estimated likelihood of acute ureterolithiasis. In addition, this study sought to examine the test characteristics of ultrasound for ureteral stones and for those likely to require intervention (ie, greater than or equal to 5 mm in size).
Section snippets
Methods
This was a prospective, observational study involving a convenience sample of patients awaiting CT scan for possible ureterolithiasis between October 2006 to September 2008. The study was approved by the institutional review board. The study was conducted in a large, urban, academic ED with an annual census of about 85,000. Patients were eligible for inclusion if the treating physician had ordered a non-contrast CT scan of the abdomen and pelvis to evaluate for ureterolithiasis, but was unaware
Results
One hundred seven patients were enrolled in the study. Mean age was 38 years (SD 14 years); 58.9% were men; 48.6% had a history of prior stones; 75.7% had hematuria. Overall, 35.5% of patients in the study were found to have bladder or ureteral stones on CT. The treating physician who assessed disease likelihood was a resident in 95 cases (88.8%) and an attending in 12 cases (11.2%). The primary investigator was the attending of record for 43.0% of the subjects. Ultrasound changed the estimated
Discussion
Prior studies have demonstrated that sonographic hydronephrosis as judged by emergency physicians correlates relatively well with hydronephrosis on intravenous pyelogram [5] and CT scan [4], [9], and that the degree of sonographic hydronephrosis is related to stone size [6]. The purpose of this investigation was to determine the extent to which this sonographic finding impacts physicians' perceived likelihood of acute ureterolithiasis. Secondarily, our study sought to determine the test
Acknowledgment
The authors wish to thank Pattie Smith, RDMS, for her assistance in enrolling patients in this study and Tina Choudhri, BS, for her assistance with data entry.
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Presentations: This research was presented as an abstract at ACEP Scientific Assembly in Chicago, Oct. 27-28, 2008.