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Prevalence of alternative diagnoses in patients with suspected uncomplicated renal colic undergoing computed tomography: a prospective study

  • Julie Pernet (a1) (a2), Sandra Abergel (a1), Jerome Parra (a3), Amine Ayed (a4), Jerome Bokobza (a1), Raphaelle Renard-Penna (a4), Isabelle Tostivint (a5), Marc-Olivier Bitker (a3) (a2), Bruno Riou (a1) (a2) and Yonathan Freund (a1) (a2)...
Abstract
AbstractObjectives

Unenhanced computed tomography (CT) has become a standard imaging technique for uncomplicated renal colic in many countries. The appropriate timing of CT imaging has not been established, and guidelines recommend that this imaging be performed between 1 and 7 days of presentation. The primary objective of this study was to determine the prevalence of alternative diagnosis identified with low-dose unenhanced CT in the emergency department (ED) in patients with suspected uncomplicated renal colic.

Methods

This prospective single-centre study was carried out in a large university hospital ED. Over a 6-month period, all patients with clinically diagnosed renal colic and a plan to be discharged underwent low-dose unenhanced CT in the ED. Pregnant women, women of childbearing age not willing to have a pregnancy test, and patients who had already undergone diagnostic imaging were excluded. The primary outcome was the number and nature of the alternative diagnosis. Univariate analyses were performed to assess factors associated with the primary outcome.

Results

A total of 178 patients were screened, and 155 underwent CT in the ED. The mean age was 42.2 years; 69% were male. The diagnosis of uncomplicated renal colic was confirmed in 118 participants (76%); 27 (17%) had an inconclusive CT scan. Overall, 10 patients (6%; 95% confidence interval [CI] 3–10) had an alternative diagnosis, 5 of whom were subsequently hospitalized.

Conclusion

Low-dose unenhanced CT in the ED detects alternative diagnoses in 6% (95% CI 3–10) of patients with suspected uncomplicated renal colic, half of whom are subsequently hospitalized. Our prospective findings, which were similar to those reported in retrospective studies, are a potential argument for a systematic approach to ED imaging in suspected renal colic. Future research involving intervention and control groups would be helpful.

RÉSUMÉObjectif

La tomodensitométrie (TDM) sans densification est devenue, dans de nombreux pays, une technique d’imagerie courante dans les cas de colique néphrétique sans complications. Toutefois, le moment propice pour faire passer cet examen n’est pas établi, et, d’après les lignes directrices, l’examen devrait être effectué entre le premier et le septième jour de la consultation. L’étude avait pour objectif principal de déterminer la prévalence d’autres diagnostics que celui de colique néphrétique sans complications, posés dans des cas présumés, à l’aide de la TDM sans densification à faible dose, au service des urgences (SU).

Méthode

II s’agit d’une étude prospective, unicentrique, qui a été menée dans un SU d’un important centre hospitalier universitaire. Sur une période de 6 mois, tous les patients chez qui un diagnostic clinique de colique néphrétique avait été pose et pour lesquels la sortie était prévue ont passé une TDM sans densification à faible dose au SU. Les femmes enceintes, celles en âge de procréer qui ne souhaitaient pas passer un test de grossesse et les patients qui avaient déjà subi des examens d’imagerie diagnostique ont été écartés. Le principal critère d’évaluation était le nombre et la nature des autres diagnostics posés. Des analyses unidimensionnelles ont permis d’évaluer des facteurs associés au principal critère d’évaluation.

Résultats

Au total, 178 patients ont été sélectionnés, et 155 ont subi une TDM au SU. L’âge moyen était de 42.2 ans, et 69% des malades étaient des hommes. Le diagnostic de colique néphrétique sans complications a été confirmé chez 118 participants (76%), tandis que l’examen s’est révélé non concluant chez 27 (17%) patients. Dans l’ensemble, d’autres diagnostics ont été posés chez 10 patients (6%; intervalle de confiance à 95% [IC] 3–10), dont 5 ont dû être hospitalisés plus tard.

Conclusions

La TDM sans densification à faible dose, effectuée au SU conduit à la pose d’autres diagnostics que celui de colique néphrétique sans complications dans 6% (IC à 95% 3–10) des cas présumés, et la moitié des patients concernés doit être hospitalisée plus tard. Les résultats de cette étude prospective, comparables à ceux d’études rétrospectives, offrent un argument possible en faveur de la réalisation systématique d’examens par imagerie au SU dans les cas présumés de colique néphré tique. II serait toutefois utile de mener d’autres études comportant cette fois des groupes témoins et des groupes expérimentaux.

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Copyright
Corresponding author
Correspondence to: Dr. Yonathan Freund, Hôpital Pitie-Salpetriere - Service d’Accueil des Urgences, 47-83 Boulevard de l’Hôpital, Paris 75013, France.
Footnotes
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Presented to the 2013 French Society of Emergency Medicine Annual Assembly, June 2013, Paris, France, and the 2013 American College of Emergency Physician Research Forum, October 2013, Seattle, WA.

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References
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