| Impact in the emergency department of unenhanced CT on diagnostic confidence and therapeutic efficacy in patients with suspected renal colic: a prospective survey. 2000 ARRS President's Award. American Roentgen Ray Society. | |
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MedLine Citation:
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PMID: 11090405 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Our objective was to evaluate the impact of unenhanced CT on clinician diagnostic confidence and therapeutic efficacy in emergency department patients with clinically suspected renal colic. SUBJECTS AND METHODS: Questionnaires were completed on 93 patients who were referred to the radiology department with clinically suspected renal colic. We prospectively surveyed the clinician's diagnostic confidence and treatment plan before and after unenhanced abdominal and pelvic CT. RESULTS: Fifty-six patients (60%) had positive findings for calculi, 20 patients (22%) had normal findings, and alternative diagnoses were found in 17 patients (18%). The clinician's diagnostic certainty of stones before CT was variable with the largest frequencies at 41-60% (n = 30) and 71-90% (n = 35). The diagnostic certainty of stones after CT showed movement toward either less than or equal to 10% (n = 25) or greater than or equal to 91% (n = 51). The mean change in diagnostic confidence was 34%. Fifty-seven patients (61%) had a change in treatment plan. Specifically, the need for urology consultation as the initial treatment plan was reduced from 24 patients to one patient. Plans for admissions suggested before CT (n = 11) were nearly cut in half (n = 6) after imaging. Lastly, seven patients who would have initially been discharged were admitted to the hospital after imaging. CONCLUSION: CT significantly increased emergency department clinician diagnostic confidence and altered initial treatment decisions in patients with suspected renal colic. Most often, CT confirmed a ureteral stone and allowed appropriate discharge or urologic intervention. In a smaller subset of patients, CT established a significant alternative diagnosis that allowed the prompt initiation of appropriate treatment. |
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Authors:
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S Abramson; N Walders; K E Applegate; R C Gilkeson; M R Robbin |
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Publication Detail:
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Type: Evaluation Studies; Journal Article |
Journal Detail:
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Title: AJR. American journal of roentgenology Volume: 175 ISSN: 0361-803X ISO Abbreviation: AJR Am J Roentgenol Publication Date: 2000 Dec |
Date Detail:
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Created Date: 2001-01-03 Completed Date: 2001-01-03 Revised Date: 2008-02-15 |
Medline Journal Info:
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Nlm Unique ID: 7708173 Medline TA: AJR Am J Roentgenol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1689-95 Citation Subset: AIM; IM |
Affiliation:
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Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Colic / radiography*, therapy Data Collection Emergency Service, Hospital* Female Humans Kidney Diseases / radiography*, therapy Male Patient Admission Patient Care Planning Prospective Studies Referral and Consultation Tomography, X-Ray Computed* Treatment Outcome Ureteral Calculi / radiography |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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