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 E.
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 - Funding Information:
Christopher L. Moore, MD, declares grant funds from AHRQ and Philips Healthcare; nonfinancial support from BK Medical and GE Healthcare; ACEP consultant. Amy C. Krambeck, MD, declares consultant for Lumenis and Boston Scientific. Charles Scales, MD, MSHS, declares grant funds from NIDDK and Allena Pharmaceuticals. Melissa M. Shaw, BS, declares grant funds from AHRQ. Kevan M. Sternberg, MD, declares consultant for Bard Endourology. The other authors state that they have no conflict of interest related to the material discussed in this article.This work was supported by the Agency for Healthcare Research and Quality (AHRQ) grant R18HS023778. The authors would like to acknowledge the support of the American College of Emergency Physicians, specifically Drs Jeremiah Schuur and Arjun Venkatesh, PIs for the ACEP eQual initiative. Christopher L. Moore, MD, declares grant funds from AHRQ and Philips Healthcare; nonfinancial support from BK Medical and GE Healthcare; ACEP consultant. Amy C. Krambeck, MD, declares consultant for Lumenis and Boston Scientific. Charles Scales, MD, MSHS, declares grant funds from NIDDK and Allena Pharmaceuticals. Melissa M. Shaw, BS, declares grant funds from AHRQ. Kevan M. Sternberg, MD, declares consultant for Bard Endourology. The other authors state that they have no conflict of interest related to the material discussed in this article.
Funding Information:
This work was supported by the Agency for Healthcare Research and Quality (AHRQ) grant R18HS023778 . The authors would like to acknowledge the support of the American College of Emergency Physicians , specifically Drs Jeremiah Schuur and Arjun Venkatesh, PIs for the ACEP eQual initiative.
Publisher Copyright:
© 2019 This article is published in print and electronic format in the Journal of American College of Radiology, ©2019 by American College of Radiology; Annals of Emergency Medicine, American College of Emergency Physicians; and The Journal of Urology®, American Urological Association Education and Research, Inc.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Background: Renal colic is common, and CT is frequently utilized when the diagnosis of kidney stones 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. Methods: In conjunction with the American College of Emergency Physicians (ACEP) eQual network, we formed a nine-member panel with three physician representatives each from ACEP, the ACR, and the American Urology Association. A systematic literature review was used as the basis for a three-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 12 (45%). 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 - Background: Renal colic is common, and CT is frequently utilized when the diagnosis of kidney stones 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. Methods: In conjunction with the American College of Emergency Physicians (ACEP) eQual network, we formed a nine-member panel with three physician representatives each from ACEP, the ACR, and the American Urology Association. A systematic literature review was used as the basis for a three-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 12 (45%). 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 - CT
KW - imaging
KW - reduced radiation CT
KW - renal colic
KW - ultrasound
UR - http://www.scopus.com/inward/record.url?scp=85071003602&partnerID=8YFLogxK
U2 - 10.1016/j.jacr.2019.04.004
DO - 10.1016/j.jacr.2019.04.004
M3 - Article
C2 - 31402228
AN - SCOPUS:85071003602
SN - 1546-1440
VL - 16
SP - 1132
EP - 1143
JO - Journal of the American College of Radiology
JF - Journal of the American College of Radiology
IS - 9
ER -