ultrasound for renal colic -...

Ultrasound for Renal Colic Feb. 6, 2016

James H. Moak, MD

University of Virginia

No Disclosures

Ultrasound for Renal Colic

Ultrasound for Renal Colic

• Pro’s

– Quick

– Easy to learn

– Cost effective

– Safe

– Pretty good accuracy

Ultrasound for Renal Colic: The Pro’s

• Quick

Ultrasound for Renal Colic: The Pro’s

• Easy to learn

5th graders learning ultrasound

Ultrasound for Renal Colic: The Pro’s

• Easy to learn

Free fluid in Morison’s pouch

Ultrasound for Renal Colic: The Pro’s

• Easy to learn

Moderate hydronephrosis

Ultrasound for Renal Colic: The Pro’s

$99

$306

Cost effective

vs

Ultrasound for Renal Colic: The Pro’s

• Safe

Ultrasound for Renal Colic: The Pro’s

• Unlike CT,

no radiation

Brenner et al. NEJM 2007

Ultrasound for Renal Colic: The Pro’s

• Good sensitivity for presence of stone

– 72%-87%

• Very good sensitivity for stones > 5 mm

– 90%-91%

Ultrasound for Renal Colic: The Pro’s

• Stone visualization

Mid-pole renal calculus

Ultrasound for Renal Colic: The Pro’s

• Ureteral jets

Better accuracy ≠ better outcomes.

• N = 2759 patients

• No difference in

– complications

– serious adverse events

– pain scores

– return ED visits

– hospitalizations

Smith-Bindman et al. 2014

• “The clinical diagnosis should be supported by an appropriate

imaging procedure. Ultrasonography should be used as the primary procedure. It is a safe (no risk of radiation), reproducible and inexpensive method of urinary stone detection.”

2011 guidelines

Avoid ordering CT in young, otherwise healthy ED patients with known Hx of ureterolithiasis presenting with sx consistent with uncomplicated kidney stones.

ACEP, 2014

I rest my case

• U/S for Renal Colic

– Quick

– Easy to learn

– Cost effective

– Safe

– Good enough accuracy

References

• Brenner DJ, Hall EJ, et al. Computed tomography – an increasing source of radiation exposure. N Engl J Med 2007; 357(22):2277-2284.

• Gaspari RJ, Horst K. Emergency ultrasound and urinalysis in the evaluation of flank pain. Acad Emer Med 2005; 12(12):1180-1184.

• Goertz J, Lotterman S. Can the degree of hydronephrosis on ultrasound predict kidey stone size? AJEM 2010; 28:813-816.

• Mandavia DP, Aragona J, et al. Ultrasound training for emergency physicians—a prospective study. Acad Emerg Med 2000; 7(9):1008-1014.

• Moak JH, Lyons MS, Lindsell CJ. Bedside renal ultrasound in the evaluation of suspected ureterolithiasis. Am J Emerg Med 2012; 30(1):218-21

• Riddell J, Case A, et al. Sensitivity of emergency bedside ultrasound to detect hydronephrosis in patients with computed tomography-proven stones. West J Emerg Med 2014; 15(1):96-100.

• Rosen CL, Brown DF, et al. Ultrasonography by emergency physicians in patients with suspected ureteral colic. J Emerg Med 1998; 16:865-70.

• Smith-Bindman R, Aubin C, et al. Ultrasonography versus computed tomography for suspected nephrolithiasis. NEJM 2014; 371(12):1100-1109.

• Watkins S, Bowra J, et al. Validation of emergency physician ultrasound in diagnosing hydronephrosis in ureteric colic. Emerg Med Australas 2007; 19:188-95.