TY - JOUR
T1 - Imaging in suspected renal colic
T2 - Systematic review of the literature and multispecialty consensus
AU - Moore, Christopher L.
AU - Carpenter, Christopher R.
AU - Heilbrun, Marta L.
AU - Klauer, Kevin
AU - Krambeck, Amy C.
AU - Moreno, Courtney
AU - Remer, Erick M.
AU - Scales, Charles
AU - Shaw, Melissa M.
AU - Sternberg, Kevan M.
N1 - Publisher Copyright:
Copyright © 2019 American Urological Association Education and Research, Inc.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2019/9
Y1 - 2019/9
N2 - Purpose: Renal colic is common and CT (computerized tomography) is frequently utilized when the diagnosis of kidney stone is suspected. CT is accurate, but exposes patients to ionizing radiation and has not been shown to alter either interventional approaches or hospital admission rates. This multi-organizational transdisciplinary collaboration sought evidence-based, multispecialty consensus on optimal imaging across different clinical scenarios in patients with suspected renal colic in the acute setting. Materials and Methods: In conjunction with the ACEP (American College of Emergency Physicians) E-QUAL (Emergency Quality Network) we formed a ninemember panel with three physician representatives each from the ACEP, the ACR(American College of Radiology) and the AUA (American Urological Association). A systematic literature review was used as the basis for a 3-step modified Delphi process to seek consensus on optimal imaging in 29 specific clinical scenarios. Results: From an initial search yielding 6,337 records there were 232 relevant articles of acceptable evidence quality to guide the literature summary. At the completion of the Delphi process consensus, agreement was rated as perfect in 15 (52%), excellent in 8 (28%), good in 3 (10%) and moderate in 3 (10%) of the 29 scenarios. There were no scenarios where at least moderate consensus was not reached. CT was recommended in 7 scenarios (24%) with ultrasound in 9 (31%) and no further imaging needed in 13 (45%). Conclusions: Evidence and multispecialty consensus support ultrasound or no further imaging in specific clinical scenarios, with reduced-radiation dose CT to be employed when CT is needed in patients with suspected renal colic.
AB - Purpose: Renal colic is common and CT (computerized tomography) is frequently utilized when the diagnosis of kidney stone is suspected. CT is accurate, but exposes patients to ionizing radiation and has not been shown to alter either interventional approaches or hospital admission rates. This multi-organizational transdisciplinary collaboration sought evidence-based, multispecialty consensus on optimal imaging across different clinical scenarios in patients with suspected renal colic in the acute setting. Materials and Methods: In conjunction with the ACEP (American College of Emergency Physicians) E-QUAL (Emergency Quality Network) we formed a ninemember panel with three physician representatives each from the ACEP, the ACR(American College of Radiology) and the AUA (American Urological Association). A systematic literature review was used as the basis for a 3-step modified Delphi process to seek consensus on optimal imaging in 29 specific clinical scenarios. Results: From an initial search yielding 6,337 records there were 232 relevant articles of acceptable evidence quality to guide the literature summary. At the completion of the Delphi process consensus, agreement was rated as perfect in 15 (52%), excellent in 8 (28%), good in 3 (10%) and moderate in 3 (10%) of the 29 scenarios. There were no scenarios where at least moderate consensus was not reached. CT was recommended in 7 scenarios (24%) with ultrasound in 9 (31%) and no further imaging needed in 13 (45%). Conclusions: Evidence and multispecialty consensus support ultrasound or no further imaging in specific clinical scenarios, with reduced-radiation dose CT to be employed when CT is needed in patients with suspected renal colic.
KW - Diagnostic imaging
KW - Kidney calculi
KW - Renal colic
KW - Tomography, X-ray computed
KW - Ultrasonography
UR - http://www.scopus.com/inward/record.url?scp=85071280192&partnerID=8YFLogxK
U2 - 10.1097/JU.0000000000000342
DO - 10.1097/JU.0000000000000342
M3 - Review article
C2 - 31412438
AN - SCOPUS:85071280192
VL - 202
SP - 475
EP - 483
JO - The Journal of Urology
JF - The Journal of Urology
SN - 0022-5347
IS - 3
ER -