Findings of Non-enhanced Abdominal Computed Tomography for Pain Management of Acute Renal Colic Patients in the Emergency Department
1Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
2Department of Eergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
3Department of Emergency Medicine, Konkuk University School of medicine, Konkuk University Medical Centre, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul 143-729, South Korea
DOI: 10.22514/sv.2020.16.0056 Vol.16,Issue 2,October 2020 pp.69-74
Published: 28 October 2020
† These authors contributed equally.
Study Objectives: To identify non-enhanced computed tomography (NECT) findings related to repeated requirement of painkiller, hospitalization and revisits within 5 days of discharge among acute renal colic patients. Patients and methods: A retrospective observational study was performed for all patients (age > 18 years) with acute renal colic who visited the emergency department (ED) between 2012 and 2015. NECT findings of acute ureterolithiasis (size, location, hydronephroureter, perinephric infiltrations and soft-tissue rim sign) were analysed for their relationships to repeated administration of painkiller, hospitalization and ED revisit. Results: Of total 862 patients enrolled, 305 (35.4%) required repeated administration of pain medication. In the NECT findings, hydronephroureter was more prevalent in the repeated administration of painkiller group (61.3% vs. 53.7%), but did not show independent relationship. Sixty-eight (7.9%) were hospitalized and 44 (5.1%) returned to the ED. The significant findings associated with hospitalization were hydronephroureter (OR [Odd Ratio] 1.92, 95%CI [Confidence Intervals] 1.04–3.54) and mid (5–7 mm) / large-size (> 7mm) ureteral stones (OR 2.66, 95% CI 1.49–4.76 and OR 4.78, 95% CI 1.80–12.70). The soft-tissue rim signs (OR 2.16, 95%CI 1.07–4.37) and proximal/mid location of stones (OR 3.21, 95% CI 1.26–8.20 and OR 2.53, 95% CI 1.19–5.37) were independently associated with ED revisit. Conclusions: Among the NECT findings of acute ureterolithiasis, hydronephroureter and stones > 5 mm in size were independently associated with the need of hospitalization. The soft-tissue rim sign and proximal/mid location of stones were independently associated with ED revisit within 5 days.
Urolithiasis, Renal colic, Computed tomography, Radiology, Emergency departments
Dong Hyuk Shin,Young Hwan Lee,Sang O Park. Findings of Non-enhanced Abdominal Computed Tomography for Pain Management of Acute Renal Colic Patients in the Emergency Department. Signa Vitae. 2020. 16(2);69-74.
 Stamatelou KK, Francis ME, Jones CA, et al. (2003) Time trends in reported prevalence of kidney stones in the United States: 1976-1994. Kidney Int. 2003;63:1817-1823.
 Scales CD Jr, Smith AC, Hanley JM, et al. Urologic Diseases in America Project. Urologic Diseases in America P. Prevalence of kidney stones in the United States. Eur Urol. 2012;62:160-165.
 Fwu CW, Eggers PW, Kimmel PL, et al. Emergency department visits, use of imaging, and drugs for urolithiasis have increased in the United States. Kidney Int. 2013;83:479-486.
 Graham A, Luber S, Wolfson AB. Urolithiasis in the emergency department. Emerg Med Clin North Am. 2011;29:519-538.
 Worster A, Preyra I, Weaver B, et al. The accuracy of noncontrast helical computed tomography versus intravenous pyelography in the diagnosis of suspected acute urolithiasis: a meta-analysis. Ann Emerg Med. 2002;40:280-286.
 Pfister SA, Deckart A, Laschke S, et al. Unenhanced helical computed tomography vs intravenous urography in patients with acute flank pain: accuracy and economic impact in a randomized prospective trial. Eur Radiol. 2003;13:2513-2520.
 Sheafor DH, Hertzberg BS, Freed KS, et al. Nonenhanced helical CT and US in the emergency evaluation of patients with renal colic: prospective comparison. Radiology. 2000;217:792-797.
 Colistro R, Torreggiani WC, Lyburn ID, et al. Unenhanced helical CT in the investigation of acute flank pain. Clin Radiol. 2002;57:435-441.
 Ulahannan D, Blakeley CJ, Jeyadevan N, et al. Benefits of CT urography in patients presenting to the emergency department with suspected ureteric colic. Emerg Med J. 2008;25:569-571.
 Dalrymple NC, Verga M, Anderson KR, et al. The value of unenhanced helical computerized tomography in the management of acute flank pain. J Urol. 1998;159: 735-740.
 Tamm EP, Silverman PM, Shuman WP. Evaluation of the patient with flank pain and possible ureteral calculus. Radiology. 2003;228:319-329.
 Coll DM, Varanelli MJ, Smith RC. Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. AJR Am J Roentgenol. 2002;178:101-103.
 Al-Nakshabandi NA. The soft-tissue rim sign. Radiology. 2003;229:239-240.
 Takahashi N, Kawashima A, Ernst RD et al. Ureterolithiasis: can clinical outcome be predicted with unenhanced helical CT? Radiology. 1988;208:97-102.
 Ege G, Akman H, Kuzucu K, et al. Acute ureterolithiasis: incidence of secondary signs on unenhanced helical CT and influence on patient management. Clin Radiol. 2003;58:990-994.
 Preminger GM, Tiselius HG, Assimos DG, et al. 2007 Guideline for the management of ureteral calculi. Eur Urol. 2007;52:1610-1631.
 Katz DS, Lane MJ, Sommer FG. Unenhanced helical CT of ureteral stones: incidence of associated urinary tract findings. AJR Am J Roentgenol. 1996;66:1319-1322.
 Ganesan V, Loftus CJ, Hinck B, et al. Clinical Predictors of 30-Day Emergency Department Revisits for Patients with Ureteral Stones. J Urol. 2016;96:1467-1470.
 Guest AR, Cohan RH, Korobkin M, et al. Assessment of the clinical utility of the rim and comet-tail signs in differentiating ureteral stones from phleboliths. AJR Am J Roentgenol. 2001;177:1285-1291.
 Kawashima A, Sandler CM, Boridy IC, et al. Unenhanced helical CT of ureterolithiasis: value of the tissue rim sign. AJR Am J Roentgenol. 1997;168:997-1000.
 Yoshida T, Inoue T, Taguchi M, et al. Ureteral wall thickness as a significant factor in predicting spontaneous passage of ureteral stones of ≤ 10 mm: a preliminary report. 2019;37:913-919.
 Vallerand AH, Polomano RC. The relationship of gender to pain. Pain Manag Nurs. 2000;1:8-15.
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