Purpose
Renal colic is a common clinical presentation in emergency department. CT KUB is widely used as the preferred imaging investigation for ED patients with suspected renal colic in concordance with BAUS, ACEM and NICE guidelines.4, 7, 8
Although the estimated effective dose of CT KUB is relatively low, it carries the burden of radiation exposure to patients. It is imperative to ensure appropriate use of CT KUB in achieving necessary diagnostic information without exposing patients to excessive radiation through overuse.
The audit aims to assess...
Methods and materials
Patients who presented to emergency department with suspected renal colic and subsequently underwent CT KUB between 1 October 2017 and 31 March 2018 were identified retrospectively using PACS.
Exclusion criteria includes:
Urinary tract infection
Known persisting renal calculus within 6 months prior to the CT KUB
Follow-up for renal calculus
A 128-slice helical CT scanner performed at 100kV, 35mA and 2.0 mm width was used to scan the patients.
All CT KUB images were either primarily or secondarily reviewed by a consultant radiologist.
The CT...
Results
246 patients were identified to have met the inclusion criteria: 38% of the patients were female and 62% were male.
The mean age was 49 years (range, 15 – 89 years).
136 patients were positive for urolithiasis (55.3%) and 100/136 (73.5%) cases were accompanied by hydronephrosis.
The positive rate is higher in males (65.4%) compared to females (38.7%) with a statistically significant difference between gender, p < 0.001. No statistically significant association is identified between age and positive diagnosis.
For patients with diagnostic yield of...
Conclusion
The rate of positive urolithiasis and significant alternative diagnoses for the ED patients who underwent CT KUB this institute were comparable to other published studies.3,5 There is statistically significant association between gender and diagnostic yield of urolithiasis, with male predominance. Together with good history taking and clinical assessment, this audit supports the use of CT KUB as the preferred imaging modality for investigation of suspected renal colic with good diagnostic yield. However, it is noted that there is a significant percentage of negative CT KUB...
References
Bultitude M, Rees J. Management of renal colic. BMJ. 2012;345:e5499.
Curhan GC. Epidemiology of stone disease. Urol Clin N Am 2007;34:287-93.
Patatas K, Panditaratne N, Wah TM, Weston MJ, Irving HC. Emergency department imaging protocol for suspected acute renal colic: re-evaluating our service. Br J Radiology. 2012;85(1016):1118-1122. DOI: 10.1259/bjr/62994625.
Tsiotras A, Smith RD, Pearce Im O'Flynn Kieran, Wideman O. British Association of Urological Surgeons standards for management of acute ureteric colic. Journal of Clinical Urology 2018, Vol. 11(1) 58-61. DOI: 10.1177/2051415817740492.
Pernet J, Abergel S,...