Predictive values of haematuria and hydronephrosis in suspected renal colic: An emergency department retrospective audit

PURPOSE: To retrospectively evaluate the prevalence of reported and unreported potentially important incidental findings in consecutive nonenhanced abdominal CTs performed specifically for renal colic in the urgent setting. METHOD: One radiologist, blinded to the finalized report, retrospectively re-evaluated nonenhanced abdominal CTs performed from January through December 2017 on adult patients from the Emergency Department with the specific request of urgent evaluation for renal colic, searching for potentially important incidental findings. RESULTS: The CTs of 312 patients were included in the study. Thirty-eight findings were reported in 38 different CTs, whereas the re-evaluation added 47 unreported findings in 47 different CTs, adding to total of 85 findings (27%). The difference in the proportion of reported and unreported potentially important incidental findings between the original report and re-evaluation was significant (P<.001). No significant difference was found between the age of patients with and without reported findings. The proportion of potentially important findings did not vary significantly among the three shifts neither in the original report nor in the re-evaluation. The most frequent findings, both reported and unreported, were pleural effusion, lymphadenopaties and liver nodules. CONCLUSIONS: Potentially important additional findings are frequently present in urgent nonenhanced abdominal CTs performed for renal colic, and many are not described in the finalized reports. Radiologists should take care not to under report potentially important incidental findings even in the urgent setting because of the possible consequences on the patient’s health status and in order to avoid legal issues, while satisfying the need for timely and efficient reporting.

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A multicenter evaluation of viral bloodstream detections in children presenting to the Emergency Department with suspected systemic infection

BMC Pediatrics ◽

10.1186/s12887-021-02699-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Christina A. Rostad ◽

Neena Kanwar ◽

Jumi Yi ◽

Claudia R. Morris ◽

Jennifer Dien Bard ◽

...

Keyword(s):

Emergency Department ◽

Whole Blood ◽

Bacterial Infections ◽

Viral Infections ◽

Systemic Infection ◽

Common Symptom ◽

Predictive Values ◽

Healthcare Facilities ◽

Tract Infections ◽

Systemic Infections

Abstract Background Fever is a common symptom in children presenting to the Emergency Department (ED). We aimed to describe the epidemiology of systemic viral infections and their predictive values for excluding serious bacterial infections (SBIs), including bacteremia, meningitis and urinary tract infections (UTIs) in children presenting to the ED with suspected systemic infections. Methods We enrolled children who presented to the ED with suspected systemic infections who had blood cultures obtained at seven healthcare facilities. Whole blood specimens were analyzed by an experimental multiplexed PCR test for 7 viruses. Demographic and laboratory results were abstracted. Results Of the 1114 subjects enrolled, 245 viruses were detected in 224 (20.1%) subjects. Bacteremia, meningitis and UTI frequency in viral bloodstream-positive patients was 1.3, 0 and 10.1% compared to 2.9, 1.3 and 9.7% in viral bloodstream-negative patients respectively. Although viral bloodstream detections had a high negative predictive value for bacteremia or meningitis (NPV = 98.7%), the frequency of UTIs among these subjects remained appreciable (9/89, 10.1%) (NPV = 89.9%). Screening urinalyses were positive for leukocyte esterase in 8/9 (88.9%) of these subjects, improving the ability to distinguish UTI. Conclusions Viral bloodstream detections were common in children presenting to the ED with suspected systemic infections. Although overall frequencies of SBIs among subjects with and without viral bloodstream detections did not differ significantly, combining whole blood viral testing with urinalysis provided high NPV for excluding SBI.

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Determinants of pyelonephritis onset in patients with obstructive urolithiasis

Urologia Journal ◽

10.1177/03915603211035244 ◽

2021 ◽

pp. 039156032110352

Author(s):

Georges Abi Tayeh ◽

Ali Safa ◽

Julien Sarkis ◽

Marwan Alkassis ◽

Nour Khalil ◽

...

Keyword(s):

Emergency Department ◽

Renal Colic ◽

Demographic Data ◽

Vital Signs ◽

Kidney Injury ◽

Stone Size ◽

Positive Urine ◽

Life Threatening ◽

Fat Stranding ◽

Obstructive Pyelonephritis

Background: Acute obstructive pyelonephritis due to urolithiasis represents a medico-surgical emergency that can lead to life-threatening complications. There are still no established factors that reliably predict progression toward acute pyelonephritis in patients presenting with a simple renal colic. Objective: To investigate clinical and paraclinical factors that are associated with the onset of acute obstructive pyelonephritis. Methods: Patients presenting to the emergency department for renal colic with obstructive urolithiasis on imaging were enrolled in the study. Demographic data, vital signs, medical comorbidities, blood test results, urinalysis, and radiological findings were recorded. Obstructive pyelonephritis was defined by the presence of two or more of the following criteria: fever, flank pain or costovertebral angle tenderness, and a positive urine culture. Results: Seventeen patients out of 120 presenting with renal colic, were diagnosed with acute obstructive pyelonephritis (14%). Parameters that were associated with the onset of obstructive pyelonephritis were: diabetes ( p = 0.03), elevated CRP ( p = 0.01), stone size (>5 mm) ( p = 0.03), dilatation of renal pelvis ( p = 0.01), peri-renal fat stranding ( p = 0.02), and positive nitrites on urinalysis ( p < 0.01). Hyperleukocytosis, acute kidney injury, multiple stones, pyuria (>10/mm3), hypertension, and were not associated with the onset of obstructive pyelonephritis. Conclusion: This study showed that known diabetic status, elevated CRP, positive urine nitrites, stone size (>5 mm), pyelic dilatation, and peri-renal fat stranding were associated with the onset of pyelonephritis in patients presenting to the emergency department with obstructive urolithiasis.

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Renal colic, where is it headed? An observational study

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2016.1.7 ◽

2016 ◽

Vol 88 (1) ◽

pp. 7 ◽

Cited By ~ 2

Author(s):

Paolo Beltrami ◽

Andrea Guttilla ◽

Lorenzo Ruggera ◽

Patrizia Bernich ◽

Filiberto Zattoni

Keyword(s):

Emergency Department ◽

Urinary Tract ◽

Observational Study ◽

Clinical Management ◽

Renal Colic ◽

Ureteral Stone ◽

Ureteral Calculi ◽

Ureteral Calculus ◽

Spontaneous Expulsion ◽

Pain Symptoms

Aim: In the last thirty years, the treatment for renal and ureteral calculi has undergone profound variations. The objective of this study has been to evaluate the existence of parameters which can affect the spontaneous expulsion of a symptomatic ureteral stone in a reasonably brief period of time and to identify whether certain parameters such as sex, age, the location and dimension of the stone, the presence of dilation in the urinary tract together with the administered therapy, can be used for a correct clinical management of the patient. Methods: In a period of 9 months, 486 cases of renal colic were registered at emergency department. Results: The cases of renal colic due to ureteral calculus were 188 (38.7%). The patients’ charts, complete of all data and therefore, valid for this research, resulted to be 120 (64%). In the presence of a symptomatic ureteral stone, the correct approach must first of all, focalize on the dimension of the calculus itself; less importance instead, is given to the location, as reported in other studies, the presence of hydroureteronephrosis, sex and the side. Conclusion: In the cases when the pain symptoms cannot be solved by means of the administration of analgesics, it is then reasonable to take into consideration an immediate endourological treatment. If the pain symptoms are promptly solved, an attentive wait of 4 weeks should be considered reasonable in order to allow spontaneous expulsion of the calculus.

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Impact of a Health Information Technology–Enabled Appropriate Use Criterion on Utilization of Emergency Department CT for Renal Colic

American Journal of Roentgenology ◽

10.2214/ajr.18.19966 ◽

2019 ◽

Vol 212 (1) ◽

pp. 142-145 ◽

Cited By ~ 4

Author(s):

Ali S. Raja ◽

Sarvenaz Pourjabbar ◽

Ivan K. Ip ◽

Christopher W. Baugh ◽

Aaron D. Sodickson ◽

...

Keyword(s):

Emergency Department ◽

Information Technology ◽

Health Information Technology ◽

Health Information ◽

Renal Colic ◽

Appropriate Use

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MP10: Does arrival pain severity predict stone characteristics or short-term outcomes in emergency department patients with acute renal colic?

CJEM ◽

10.1017/cem.2020.158 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S45-S46

Author(s):

G. Splinter ◽

K. Gourlay ◽

J. Hayward ◽

G. Innes

Keyword(s):

Emergency Department ◽

Severe Pain ◽

Renal Colic ◽

Pain Severity ◽

Secondary Outcome ◽

Advanced Imaging ◽

Stone Size ◽

Pain Scores ◽

Imaging Results ◽

Stone Characteristics

Introduction: Renal colic is among the most painful conditions that patients experience. The main outcome determinants for patients with renal colic are stone size, location and hydronephrosis; however, little is known about the association of pain with these parameters. Our objective was to determine whether more severe pain is associated with larger stones, more proximal stones or more severe hydronephrosis, findings that might suggest the need for advanced imaging, hospitalization or early intervention. Methods: We used administrative data and structured chart review to study all adult emergency department (ED) patients in two cities with a renal colic diagnosis over one-year. Patients with missing imaging results or pain scores were excluded. Triage nurses recorded numeric rating scale (NRS) pain scores on arrival. We stratified patients into mild (NRS <4), moderate (NRS 4-7) and severe (NRS 8-10) pain groups, as per CTAS guidelines. Stone size (mm) and location (proximal, middle, distal ureter, or renal) were abstracted from imaging reports, while index admissions were determined from hospital discharge abstracts. We used multivariable linear regression to determine the association of arrival pain with stone characteristics and hydronephrosis severity (primary outcome), and we used multivariable logistic regression to determine the association of pain with index hospitalization (secondary outcome). We also performed a stratified analysis looking at ureteral vs. kidney (intrarenal) stones. Results: We studied 1053 patients, 66% male, with a mean age of 48 years. After controlling for patient and disease characteristics, we found no significant association between pain severity and stone size (b=−0.0004; 95%CI = -0.0015, 0.0008) or stone location (b = 0.0045; 95%CI: -0.020, 0.029). Nor did we find an association between pain and hydronephrosis severity (b = 0.016; 95%CI: -0.053, 0.022, p = 0.418). Stratified analyses using a Bonferroni correction for multiple comparisons revealed the same absence of associations in the kidney and ureteral stone subgroups. Arrival pain did not predict index admission (OR = 0.82, 95% CI: 0.59, 1.16). Conclusion: Arrival pain scores are not associated with stone size, stone location or hydronephrosis severity, and do not predict index visit hospitalization in ED patients with renal colic. Severe pain should motivate efforts to minimize treatment delays, but do not suggest the need to modify advanced imaging or admission decisions.

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

10.22514/sv.2020.16.0056 ◽

2020 ◽

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Soft Tissue ◽

Renal Colic ◽

Repeated Administration ◽

Pain Medication ◽

Ureteral Stones ◽

Large Size ◽

Acute Renal Colic ◽

Enhanced Computed Tomography

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.

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Lactic acid level as an outcome predictor in pediatric patients with intussusception in the emergency department

10.21203/rs.2.20037/v3 ◽

2020 ◽

Author(s):

Jeong-Yong Lee ◽

Young-Hoon Byun ◽

Jun-Sung Park ◽

Jong Seung Lee ◽

Jeong-Min Ryu ◽

...

Keyword(s):

Emergency Department ◽

Lactic Acid ◽

Acid Level ◽

Pediatric Patients ◽

Lactic Acid Level ◽

Predictive Values ◽

The Poor ◽

Two Factors ◽

Blood Gas Analyses ◽

Poor Outcomes

Abstract Background: Intussusception decreases blood flow to the bowel, and tissue hypoperfusion results in increased lactic acid levels. We aimed to determine whether lactic acid levels are associated with pediatric intussusception outcomes. Methods: The electronic medical records of our emergency department pediatric patients diagnosed with intussusception, between January 2015 and October 2018, were reviewed. An outcome was considered poor when intussusception recurred within 48 hours of reduction or when surgical reduction was required due to air enema failure. Results: A total of 249 patients were included in the study, including 39 who experienced intussusception recurrence and 11 who required surgical reductions; hence, 50 patients were included in the poor outcome group. The poor and good outcome groups showed significant differences in their respective blood gas analyses for pH (7.39 vs. 7.41, P = .001), lactic acid (1.70 vs. 1.30 mmol/L, P < .001), and bicarbonate (20.70 vs. 21.80 mmol/L, P = .036). Multivariable logistic regression analyses showed that pH and lactic acid levels were the two factors significantly associated with poor outcomes. When the lactic acid level cutoff values were ≥1.5, ≥2.0, ≥2.5, and ≥3.0 mmol/L, the positive predictive values for poor outcomes were 30.0%, 34.6%, 50.0%, and 88.9%, respectively. Conclusion: Lactic acid levels affect outcomes in pediatric patients with intussusception; higher lactic acid levels are associated with higher positive predictive values for poor outcomes.

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