Article Data

  • Views 93
  • Dowloads 5

Original Research

Open Access

Findings of Non-enhanced Abdominal Computed Tomography for Pain Management of Acute Renal Colic Patients in the Emergency Department

  • Dong Hyuk Shin1,†
  • Young Hwan Lee2,†
  • Sang O Park3

1Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, P. R. Korea

2Department of Eergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, P. R. 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, P. R. Korea

DOI: 10.22514/sv.2020.16.0056

Online publish date: 16 September 2020

*Corresponding Author(s): Sang O Park E-mail: empso@kuh.ac.kr

† These authors contributed equally.

PDF (198.17 kB)

Abstract

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.

Key words

Urolithiasis, Renal colic, Computed tomography, Radiology, Emergency departments

Cite And Share

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.doi:10.22514/sv.2020.16.0056.

References

[1] 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.

[2] 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.

[3] 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.

[4] Graham A, Luber S, Wolfson AB. Urolithiasis in the emergency department. Emerg Med Clin North Am. 2011;29:519-538.

[5] 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.

[6] 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.

[7] 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.

[8] Colistro R, Torreggiani WC, Lyburn ID, et al. Unenhanced helical CT in the investigation of acute flank pain. Clin Radiol. 2002;57:435-441.

[9] 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.

[10] 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.

[11] Tamm EP, Silverman PM, Shuman WP. Evaluation of the patient with flank pain and possible ureteral calculus. Radiology. 2003;228:319-329.

[12] 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.

[13] Al-Nakshabandi NA. The soft-tissue rim sign. Radiology. 2003;229:239-240.

[14] Takahashi N, Kawashima A, Ernst RD et al. Ureterolithiasis: can clinical outcome be predicted with unenhanced helical CT? Radiology. 1988;208:97-102.

[15] 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.

[16] Preminger GM, Tiselius HG, Assimos DG, et al. 2007 Guideline for the management of ureteral calculi. Eur Urol. 2007;52:1610-1631.

[17] 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.

[18] 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.

[19] 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.

[20] 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.

[21] 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.

[22] Vallerand AH, Polomano RC. The relationship of gender to pain. Pain Manag Nurs. 2000;1:8-15.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) The Science Citation Index (SCI) is a citation index originally produced by the Institute for Scientific Information (ISI) and created by Eugene Garfield. It (Science Citation Index Expanded) covers more than 8,500 notable and significant journals, across 150 disciplines in science and technology, from 1900 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

    Top