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Appropriately investigating first presentation of acute renal colic and the diagnostic yield of CT KUB for renal calculi and alternative diagnoses in adults
EP29177
Poster Title: Appropriately investigating first presentation of acute renal colic and the diagnostic yield of CT KUB for renal calculi and alternative diagnoses in adults
Submitted on 14 Sep 2018
Author(s): Dr Farah Aslam
Affiliations: Newham University Hospital
This poster was presented at Dr Farah Aslam
Poster Views: 437
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Poster Information
Abstract: Background: Guidance by NICE and European Association of Urology (EAU) state diagnostic investigation by non-contrast computed tomography (CT-KUB) is the imaging modality of choice for acute renal colic.1,2 However, despite performing low-dose CT scans, radiation exposure still remains. It is therefore important to identify appropriate use of CT-KUB and assess if a reasonable diagnostic yield is achieved. Based on published studies this is detecting calculi in at least 44% of patients and alternative diagnoses in at least 6%.3,4 Patients should have a CT-KUB performed within 24 hours of request.

Method: A retrospective study over 9 months identified 75 adult patients with first episode of acute renal colic who were investigated with a non-contrast CT-KUB.

Results: Data collected for 75 patients comprised of 46 males and 29 females; ranging from 21 to 88 years of age. 93% (70/75) of CT-KUB scans were completed within 24 hours of presentation. A delay between 27.5 -- 32 hours for having the scan occurred in the remaining 7% (5/75); owing to weekend requests. CT-KUB successfully diagnosed calculi in 88% (66/75). A further 8% (6/75) had an alternative diagnosis (appendicitis, pyelonephritis, bladder malignancy) with an unidentified cause of acute renal colic in 4% (3/75).

Conclusion: CT-KUB provided good diagnostic yield for detecting calculi and recognizing alternative diagnoses. However, the accessibility to weekend scans needs to be addressed by liaising with the radiology department. Perhaps performing an ultrasound scan in cases of delay is an alternative, safe and non-radiating option to confirm or refute a renal pathology.
Summary: Auditing against guidance provided by NICE and European Association of Urology (EAU) for appropriately investigating first presentation of acute renal colic and the diagnostic yield of CT KUB for renal calculi and alternative diagnoses in adults at a district general hospital. References:
1. iREFER guidelines. U04. Suspected ureteric colic. RCR 2017 https://www.irefer.org.uk/guidelines
2. NICE guidance: Renal or ureteric colic – acute. Revised April 2015. https://cks.nice.org.uk/renal-or-ureteric-colic-acute
3. British Association of Urological Surgeons (BAUS) guidelines for acute management of first presentation of renal/ureteric lithiasis, December 2008. http://www.bauslibrary.co.uk/PDFS/BSEND/Stone_GuidelinesDec2008.pdf
4. European Association of Urology (2014) Guidelines on urolithiasis.European Association of Urology. http://uroweb.org/guideline/urolithiasis/
5. Chowdhury FU, Kotwal S, Raghunathan G et al. Unenhanced multidetector CT (CT KUB) in the initial imaging of suspected acute renal colic: evaluating a new service. Clin Radiol. 2007 Oct;62(10):970-7.
6. Meagher T, Sukumar VP, Collingwood J, et al. Low dose computed tomography in suspected acute renal colic. Clin Radiol. 2001 Nov;56(11):873-6.
7. Greenwell TJ, Woodhams S, Dento
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