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INTRODUCTION: Renal colic accounts for 5-10% of all emergency department visits, making it a common condition in acute medicine. The typical clinical presentation is an early indication of urolithiasis. DIAGNOSIS: Diagnostic measures include laboratory tests, ultrasound, and low-dose noncontrast computed tomography (CT) scans. Kidney, ureter, bladder (KUB) plain film radiography has been widely replaced by low-dose noncontrast CT with similar radiation dosage. In special patient groups such as children or pregnant women, ionizing radiation should be avoided if possible. TREATMENT: General measures involve pain management (non-steroidal anti-inflammatory agents, opioids) and empirical antibiotic treatment for suspected bacterial infection. Depending on the location/size of the stone, pharmacological stone expulsion therapy may be considered. In cases of obstructive pyelonephritis or acute renal insufficiency, early urinary drainage (JJ stent/nephrostomy) is recommended. Definitive stone removal may be performed primarily in some cases (rather small and rather distal ureterolithiasis). It is common to schedule stone removal as a secondary intervention.
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Cólico Renal , Humanos , Cólico Renal/etiología , Cólico Renal/diagnóstico , Cólico Renal/terapia , Tomografía Computarizada por Rayos XRESUMEN
An 11-year-old otherwise healthy female presented with renal colic and during computed tomography imaging evaluation, she was found to have a right distal ureteral stone with associated hydroureteronephrosis, medially deviated ureter, and 4-cm solid retroperitoneal mass. The mass was palpable on physical exam and was further categorized with magnetic resonance imaging, ultrasound, and laboratory testing. A multidisciplinary team approach, including pediatric surgery, radiology, oncology, and urology, led to the patient undergoing a right retrograde pyelogram, ureteroscopy with stent placement, and laparoscopic excision of retroperitoneal mass. Her pathology revealed lymphoid hyperplasia with histologic features of Castleman disease.
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Enfermedad de Castleman , Cólico Renal , Uréter , Cálculos Ureterales , Urología , Humanos , Niño , Femenino , Cólico Renal/diagnóstico , Cólico Renal/etiología , Enfermedad de Castleman/complicaciones , Enfermedad de Castleman/diagnóstico , Enfermedad de Castleman/cirugía , Uréter/cirugía , Cálculos Ureterales/cirugíaRESUMEN
To explore the preference for diagnosing and treating renal colic during pregnancy among Chinese urologists. A questionnaire was designed using the Sojump® platform. WeChat, the largest social networking platform in China, was used to distribute the questionnaire to urologists at hospitals of all levels in China. In total, 110 responses were included. Of the respondents, 100.0% used ultrasound to diagnose renal colic during pregnancy, followed by magnetic resonance imaging (17.3%) and low-dose CT (3.6%). Phloroglucinol (80.9%) and progesterone (72.7%) were the most commonly used antispasmodics and analgesics. Opioid analgesics were not commonly used (12.7%). Most of the respondents (63.6%) indicated that no more than 20% of the patients needed surgical intervention. If surgery was unavoidable, 95.5% preferred temporary renal drainage, including ureteral stenting (92.7%) and percutaneous nephrostomy (2.7%). However, some respondents still preferred definitive stone treatment, such as ureteroscopy lithotripsy (3.6%) and percutaneous nephrolithotomy (0.9%). Moreover, there were no differences in the choices of urologists with different professional titles regarding diagnostic tools, most therapeutic medications, or surgical methods (p > 0.05). Ultrasound is the preferred tool for diagnosing renal colic during pregnancy. Low-dose CT is still not widely accepted. Pregnant patients with renal colic are initially treated conservatively. Urologists prefer ureteral stenting when there are clinical indications for intervention.
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Cólico Renal , Uréter , Cálculos Ureterales , Embarazo , Femenino , Humanos , Cólico Renal/diagnóstico , Cólico Renal/terapia , Urólogos , Ureteroscopía/métodos , Encuestas y Cuestionarios , Cálculos Ureterales/terapiaRESUMEN
INTRODUCTION: Physical examination appears to be a limiting factor of teleconsultation (TC). We evaluated the feasibility of self-percussion of the lumbar fossae (sPLF) and TC for simple renal colic (SRC) in comparison with a face-to-face consultation (FC). MATERIAL AND METHODS: We performed a comparative prospective study in two steps. First: evaluation of the quality of an sPLF on a standardized patient in TC, without and with tutorial. Secondarily: evaluation of a TC and a FC for a SRC with a standardized patient in real conditions. Evaluation using objective clinical scores and qualitative scales by an observer, the standardized patient and the practitioner himself. RESULTS: Forty-two practitioners were included in the study. In the absence of a tutorial, the sPLF was most often "poorly done". The tutorial led to a significant improvement in the quality of sPLF. There was no difference in diagnostic and therapeutic performance among senior physicians between TC and FC. The therapeutic performances of the interns were significantly lower in TC without his being aware of it. The qualitative scores were significantly lower in TC vs FC according to the practitioners, the standardized patient and the observer. CONCLUSION: An sPLF is feasible but its practice should be taught. Unlike interns, senior physicians were able to perform a TC comparable to FC for the management of SRC. TC and telesemiology therefore require dedicated training and an experienced practitioner.
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Médicos , Consulta Remota , Cólico Renal , Humanos , Estudios Prospectivos , Cólico Renal/diagnóstico , Cólico Renal/etiología , Cólico Renal/terapiaRESUMEN
Introducción y objetivo Verificar el impacto en los resultados bioquímicos y clínicos de la demora en acudir al servicio de Urgencias (SU) ante un cólico renal agudo. Materiales y métodos Los datos se recogieron retrospectivamente en 3 instituciones de 2 países europeos, desde el 1 de enero hasta el 30 de abril del 2020. Se incluyó a los pacientes que acudieron a Urgencias con un cólico renal unilateral o bilateral causado por urolitiasis confirmada por imagen durante el periodo de estudio. La consulta en el SU después de 24 h desde el inicio de los síntomas se consideró tardía. Los pacientes que acudieron antes de las 24 h desde el inicio de los síntomas se incluyeron en el grupo A y los pacientes que se presentaron después de las 24 h se adjudicaron al grupo B. Se compararon los parámetros clínicos y bioquímicos, así como el manejo recibido por cada paciente. Resultados Se analizó a 397 pacientes que acudieron a Urgencias con urolitiasis confirmada (grupo A, n = 199; grupo B, n = 198). La mediana (RIC) de demora hasta la consulta fue de 2 días (1,5-4). En el momento de la consulta, no se encontraron diferencias estadísticamente significativas entre los 2 grupos de pacientes en cuanto a los síntomas como fiebre y dolor en el flanco, o la mediana de los niveles séricos de creatinina, proteína C reactiva y leucocitos. No se encontraron diferencias en cuanto al tratamiento conservador o quirúrgico. Conclusiones La demora > 24 h hasta acudir al SU no se asocia a un empeoramiento de los parámetros bioquímicos ni de los resultados clínicos. La mayoría de los pacientes con dolor lumbar agudo no siempre necesitan acudir de forma inmediata a urgencias, pudiendo ser tratados en consultas externas (AU)
Introduction and objective To verify the impact of delay on biochemical and clinical outcomes for patients presenting to the emergency department (ED) with acute renal colic. Materials and methods Data were retrospectively collected from 3 institutions of 2 European countries between 01 January and 30 April 2020. Patients who presented to the ED with unilateral or bilateral renal colic caused by urolithiasis confirmed by imaging tests during the study period were included. A presentation after 24 hours since the onset of symptoms was considered a delay. Patients presenting before 24 hours from the symptom onset were included in Group A, while the patients presenting after 24 hours in Group B. Clinical and biochemical parameters and management were compared. Results 397 patients who presented to ED with confirmed urolithiasis were analyzed (Group A, n = 199; Group B, n = 198. The median (IQR) delay in presentation was 2 days (1,5-4). At presentation, no statistically significant differences were found amongst the 2 groups of patients regarding presenting symptoms such as fever and flank pain, and the median serum levels of creatinine, C reactive protein and white blood cells. No differences were found in terms of conservative or operative management. Conclusions Delay in consultation >24 hours is not associated with worsening biochemical parameters and clinical outcomes. Most patients with acute loin pain do not necessarily need urgent attendance to the ED and may be managed in the outpatients (AU)
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Servicio de Urgencia en Hospital , Cólico Renal/diagnóstico , Cólico Renal/etiología , Urolitiasis/complicaciones , Urolitiasis/diagnóstico , Estudios Retrospectivos , Cólico Renal/terapia , Urolitiasis/terapia , Enfermedad AgudaRESUMEN
INTRODUCTION AND OBJECTIVE: To verify the impact of delay on biochemical and clinical outcomes for patients presenting to the emergency department (ED) with acute renal colic. MATERIALS AND METHODS: Data were retrospectively collected from three institutions of two European countries between 01 January and 30 April 2020. Patients who presented to the ED with unilateral or bilateral renal colic caused by urolithiasis confirmed by imaging tests during the study period were included. A presentation after 24â¯h since the onset of symptoms was considered a delay. Patients presenting before 24â¯h from the symptom onset were included in Group A, while the patients presenting after 24â¯h in Group B. Clinical and biochemical parameters and management were compared. RESULTS: A total of 397 patients who presented to ED with confirmed urolithiasis were analyzed (Group A, nâ¯=â¯199; Group B, nâ¯=â¯198. The median (IQR) delay in presentation was 2 days (1,5-4). At presentation, no statistically significant differences were found amongst the two groups of patients regarding presenting symptoms such as fever and flank pain, and the median serum levels of creatinine, C reactive protein and white blood cells. No differences were found in terms of conservative or operative management. CONCLUSION: Delay in consultation >24â¯h is not associated with worsening biochemical parameters and clinical outcomes. Most patients with acute loin pain do not necessarily need urgent attendance to the ED and may be managed in the outpatients.
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Cólico Renal , Urolitiasis , Humanos , Cólico Renal/diagnóstico , Cólico Renal/etiología , Cólico Renal/terapia , Estudios Retrospectivos , Urolitiasis/complicaciones , Urolitiasis/diagnóstico , Urolitiasis/terapia , Servicio de Urgencia en Hospital , Europa (Continente)RESUMEN
OBJECTIVE: To evaluate whether patients discharged to home after an emergency department (ED) visit for headache face a heightened short-term risk of stroke. BACKGROUND: Stroke hospitalizations that occur soon after ED visits for headache complaints may reflect diagnostic error. METHODS: We conducted a retrospective cohort study using statewide administrative claims data for all ED visits and admissions at nonfederal hospitals in Florida 2005-2018 and New York 2005-2016. Using standard International Classification of Diseases (ICD) codes, we identified adult patients discharged to home from the ED (treat-and-release visit) with a benign headache diagnosis (cohort of interest) as well as those with a diagnosis of renal colic or back pain (negative controls). The primary study outcome was hospitalization within 30 days for stroke (ischemic or hemorrhagic) defined using validated ICD codes. We assess the relationship between index ED visit discharge diagnosis and stroke hospitalization adjusting for patient demographics and vascular comorbidities. RESULTS: We identified 1,502,831 patients with an ED treat-and-release headache visit; mean age was 41 (standard deviation: 17) years and 1,044,520 (70%) were female. A total of 2150 (0.14%) patients with headache were hospitalized for stroke within 30 days. In adjusted analysis, stroke risk was higher after headache compared to renal colic (hazard ratio [HR]: 2.69; 95% confidence interval [CI]: 2.29-3.16) or back pain (HR: 4.0; 95% CI: 3.74-4.3). In the subgroup of 26,714 (1.78%) patients with headache who received brain magnetic resonance imaging at index ED visit, stroke risk was only slightly elevated compared to renal colic (HR: 1.47; 95% CI: 1.22-1.78) or back pain (HR: 1.49; 95% CI: 1.24-1.80). CONCLUSION: Approximately 1 in 700 patients discharged to home from the ED with a headache diagnosis had a stroke in the following month. Stroke risk was three to four times higher after an ED visit for headache compared to renal colic or back pain.
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Cólico Renal , Accidente Cerebrovascular , Adulto , Humanos , Femenino , Masculino , Cólico Renal/diagnóstico , Cólico Renal/epidemiología , Cólico Renal/terapia , Estudios Retrospectivos , Servicio de Urgencia en Hospital , Hospitalización , Cefalea/diagnóstico , Cefalea/epidemiología , Cefalea/terapia , Dolor de Espalda , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/terapiaRESUMEN
Low back pain is one of the most frequent reasons for consultation in primary care. Sometimes it is not easy to make a good differential diagnosis, because the number of pathologies that can express themselves with such symptoms is very wide and a complementary test or referral to the reference hospital is not always indicated. The following is a clinical case of a 59-year-old female patient with a history of dyslipidemia treated with ezetimibe, who consulted again for breakthrough low back pain, which was finally diagnosed as a penetrating ulcer of the abdominal aorta, treated endovascularly by the vascular surgery service. The clinical case aims to provide an overview of the acute treatment of aortic syndrome, showing the differences compared to the management of other common pathologies in primary care with the same clinical expression.
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Dolor de la Región Lumbar , Cólico Renal , Femenino , Humanos , Persona de Mediana Edad , Cólico Renal/diagnóstico , Cólico Renal/etiología , Cólico Renal/patología , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/etiología , Dolor de la Región Lumbar/patología , Aorta Abdominal/patología , Aorta Abdominal/cirugía , Síndrome , EzetimibaRESUMEN
INTRODUCTION: Urolithiasis affects many people throughout their lives. Among the maternal population, although the morbidity of acute urolithiasis in pregnant women is unremarkable, it is the leading cause of hospitalisation during pregnancy. There is no effective clinical diagnostic tool to help doctors diagnose diseases. Our primary aim was to develop and validate a clinical prediction model based on statistical methods to predict the probability of having disease in pregnant women who visited the emergency department because of urolithiasis-induced colic. METHODS AND ANALYSIS: We will use multivariate logistic regression analysis to build a multivariate regression linear model. A receiver operating characteristic curve plot and calibration plot will be used to measure the discrimination value and calibration value of the model, respectively. We will also use least absolute shrinkage and selection operator regression analysis combined with logistic regression analysis to select predictors and construct the multivariate regression model. The model will be simplified to an application that has been reported before, and users will only need to enter their clinical parameters so that risk probability is automatically derived. ETHICS AND DISSEMINATION: The review and approval documents of the clinical research ethics committee have been received from the ethics committee of our hospital (The Third Affiliated Hospital of Wenzhou Medical University). We will disseminate research findings through presentations at scientific conferences and publication in peer-reviewed journals.
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Cólico Renal , Urolitiasis , China/epidemiología , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Modelos Estadísticos , Embarazo , Mujeres Embarazadas , Pronóstico , Cólico Renal/diagnóstico , Cólico Renal/etiología , Estudios Retrospectivos , Urolitiasis/complicaciones , Urolitiasis/diagnóstico , Urolitiasis/epidemiologíaRESUMEN
BACKGROUND: Renal colic is the pain experienced by a patient when a renal calculus (kidney stone) causes partial or complete obstruction of part of the renal outflow tract. The standard analgesic regimes for renal colic are often ineffective; in some studies, less than half of patients achieve complete pain relief, and a large proportion of patients require rescue analgesia within 4 h. Current analgesic regimes are also associated with significant side effects including nausea, vomiting, drowsiness and respiratory depression. It has been hypothesised that beta adrenoreceptor agonists, such as salbutamol, may reduce the pain of renal colic. They have been shown to impact a number of factors that target the physiological causes of pain in renal colic (ureteric spasm and increased peristalsis, increased pressure at the renal pelvis and prostaglandin release with inflammation). There is biological plausibility and a body of evidence sufficient to suggest that this novel treatment for the pain of renal colic should be taken to a phase II clinical trial. The aim of this trial is to test whether salbutamol is an efficacious analgesic adjunct when added to the standard analgesic regime for patients presenting to the ED with subsequently confirmed renal colic. METHODS: A phase II, randomised, placebo-controlled trial will be performed in an acute NHS Trust in the East Midlands. Patients presenting to the emergency department with pain requiring IV analgesia and working diagnosis of renal colic will be randomised to receive standard analgesia ± a single intravenous injection of Salbutamol. Secondary study objectives will explore the feasibility of conducting a larger, phase III trial. DISCUSSION: The trial will provide important information about the efficacy of salbutamol as an analgesic adjunct in renal colic. It will also guide the development of a definitive phase III trial to test the cost and clinical effectiveness of salbutamol as an analgesic adjunct in renal colic. Salbutamol benefits from widespread use across the health service for multiple indications, extensive staff familiarity and a good side effect profile; therefore, its potential use for pain relief may have significant benefits for patient care. TRIAL REGISTRATION: ISRCTN Registry ISRCTN14552440 . Registered on 22 July 2019.
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Analgesia , Cólico Renal , Albuterol/efectos adversos , Analgesia/métodos , Analgésicos/efectos adversos , Ensayos Clínicos Fase II como Asunto , Humanos , Náusea/inducido químicamente , Dolor/tratamiento farmacológico , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Cólico Renal/inducido químicamente , Cólico Renal/diagnóstico , Cólico Renal/tratamiento farmacológicoAsunto(s)
Calcinosis/diagnóstico , Discitis/diagnóstico , Vértebras Lumbares/diagnóstico por imagen , Cólico Renal/diagnóstico , Anciano , Calcinosis/complicaciones , Diagnóstico Diferencial , Discitis/complicaciones , Discitis/microbiología , Humanos , Imagen por Resonancia Magnética , Masculino , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Ureteral stones pose a high economic and medical burden among Emergency Department (ED) admissions. Management strategies vary from expectant therapy to surgical interventions. Since predictors of ureteral spontaneous stone passage (SSP) are still not well understood, we sought to create a novel nomogram to guide management decisions. METHODS: Charts were retrospectively reviewed for patients who presented to our institution's ED with non-febrile renal colic and received a radiological diagnosis of ureteral stone ≤10 mm. Demographic, clinical, laboratory, and non-contrast CT data were collected. This novel nomogram incorporates the serum neutrophil-to-lymphocyte ratio (NLR) as a potential predictor of SSP. The model was derived from a multivariate logistic regression and was validated on a different cohort. A receiver operator characteristic (ROC) curve was constructed and the area under the curve (AUC) was computed. RESULTS: A total of 1186 patients presented to our ED between January 2010 and October 2018. We randomly divided our population into a derivation and validation cohort in one to five ratio. A stone size ≥7 mm was the strongest predictor of SSP failure; OR=9.47; 95% CI: 6.03-14.88. Similarly, a NLR≥3.14 had 2.17; (1.58-2.98) the odds of retained stone. SSP failure was also correlated with proximal position, severe hydronephrosis, and leukocyte esterase ≥75, P=0.02, P=0.05, and P=0.006, respectively. The model had an AUC of 0.804 (0.776-0.832). The nomogram was also used to compute the risk of SSP failure (AUC 0.769 [0.709-0.829]). CONCLUSIONS: Our novel nomogram can be used as a predictor for SSP and can be used clinically in decision making.
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Hidronefrosis , Nomogramas , Cólico Renal , Cálculos Ureterales , Servicio de Urgencia en Hospital , Humanos , Hidronefrosis/diagnóstico por imagen , Cólico Renal/diagnóstico , Cólico Renal/etiología , Estudios Retrospectivos , Cálculos Ureterales/diagnóstico por imagen , Cálculos Ureterales/terapiaRESUMEN
BACKGROUND: Acute renal colic caused by urinary calculi (ARCUC) has a considerable impact on the quality of life. Acupuncture might be a potential treatment option. However, the evidence is limited. We will conduct this trial to evaluate the efficacy and safety of acupuncture as adjunctive treatment to diclofenac for ARCUC. METHODS/DESIGN: A total of 80 eligible patients who are diagnosed with urinary stone renal colic will be randomly allocated to the acupuncture group or the sham acupuncture group. Each patient will receive 1 session of acupuncture or sham acupuncture. The primary outcome will be the response rate of patients achieving a reduction of > 50% on visual analog score (VAS) from baseline to 10 min after treatment. Secondary outcomes will include the VAS, remedial analgesia, re-visit and admission rate, blinding assessment, credibility and expectancy, and adverse event. All patients who receive randomization will be included in the intent-to-treat analysis. DISCUSSION: The finding of this trial will provide evidence on the efficacy and safety of acupuncture for the treatment of ARCUC. The results of this study will be published in peer-reviewed journals. TRIAL REGISTRATION: ClinicalTrials.gov ChiCTR 1900025202 . Registered on August 16, 2019.
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Terapia por Acupuntura , Cólico Renal , Cálculos Urinarios , Terapia por Acupuntura/efectos adversos , Humanos , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Cólico Renal/diagnóstico , Cólico Renal/etiología , Cólico Renal/terapia , Resultado del TratamientoRESUMEN
BACKGROUND: Ureteroscopy is widely applied in pregnant women with renal colic, but such patients are easy to experience uterine contraction after surgery. There are many factors which may affect uterine contraction, this study aims to explore the risk factors of uterine contraction triggered by ureteroscopy in pregnant women with renal colic. METHODS: One hundred and one pregnant women were retrospectively analyzed, the patients were hospitalized because of severe renal colic. All patients received ureteroscopy during which double J catheters were inserted into ureters for drainage. Patients received other medical treatments individually according to their condition and uterine contractions were detected by EHG within 12 h after operation. Patients were classified as group A (uterine contraction) and group B (no uterine contraction) according to the presence or absence of continuously regular uterine contraction. Clinical characteristics were collected for further analysis, including history of childbirth, anesthesia method, application of phloroglucinol or not, operation time, Oxygen inhalation or not, pain relief or not after surgery, systemic inflammatory response syndrome (SIRS) occurred or not. A binary logistic regression analysis model was established to explore whether such clinical characteristics were relevant to uterine contraction after ureteroscopy. RESULTS: Continuously regular uterine contraction presented in 46 pregnant women within 12 h after ureteroscopy, making the incidence of uterine contraction as high as 45.54%. The presence of uterine contraction was related to the following factors(P < 0.05): history of childbirth (primipara versus multipara)(OR 6.593, 95% CI 2.231-19.490), operation time (each quarter additional) (OR 2.385, 95% CI 1.342-4.238), application of phloroglucinol (yes versus not) (OR 6.959, 95% CI 1.416-34.194), pain relief after surgery(yes versus not)(OR 6.707, 95% CI 1.978-22.738), SIRS occurred after surgery (yes versus not) (OR 0.099, 95% CI 0.014-0.713). CONCLUSION: Continuously regular uterine contraction is easy to occur within 12 h after ureteroscopy in pregnant women. SIRS occurred after surgery is a risk factor for uterine contraction; on the contrary, no history of childbirth, shorter operation time, application of phloroglucinol, pain relief after surgery are protective factors.
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Complicaciones del Embarazo/diagnóstico , Cólico Renal/diagnóstico , Ureteroscopía/efectos adversos , Contracción Uterina , Adulto , Femenino , Humanos , Embarazo , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: Renal tract pain is a common presentation in the primary care setting that can masquerade as other abdominopelvic conditions, and vice versa. A stepwise approach to a patient with renal tract pain can aid immensely in formulating an accurate diagnosis and providing optimal care. OBJECTIVE: The aim of this article is to present current evidence-based recommendations for renal tract pain to assist in its diagnosis, assessment and management. DISCUSSION: Renal tract pain is mediated by a surge in prostaglandin release, leading to arterial vasodilatation, increased vascular permeability, and subsequently ureteric oedema and spasms. Referred and migratory pain are hallmarks of this condition and are unique to renal colic because of the progressive passage of the stone along the ureter. Diagnosis requires a stepwise approach with history-taking, assessment, blood tests and imaging. Successful management of renal tract pain necessitates a combination of analgesia and medical expulsive therapy, failing which surgical intervention is required.
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Cólico Renal , Diagnóstico por Imagen , Humanos , Dolor , Atención Primaria de Salud , Derivación y Consulta , Cólico Renal/diagnóstico , Cólico Renal/etiología , Cólico Renal/terapiaRESUMEN
BACKGROUND/AIM: Diagnostic scores (DSs) for confirmation of acute renal colic (ARCO) have rarely been evaluated. PATIENTS AND METHODS: A cohort of 1,333 patients with acute abdominal pain (AAP) were studied, including 59 patients with confirmed ARCO. The most significant diagnostic findings (in multivariate logistic regression analysis) were used to construct DS formulas for the diagnosis of ARCO. Meta-analytical techniques were used to detect the summary sensitivity and specificity estimates for each data set (clinical symptoms, signs and tests, as well as DS formulas). RESULTS: In hierarchical summary receiver operating characteristic analysis (HSROC), the values for area under the curve (95% confidence interval) for i) clinical symptoms ii) signs and tests, and iii) DS were 0.650 (0.612-0.688), 0.724 (0.680-0.768) and 0.962 (0.940-0.984), respectively. In HSROC analysis of the area under the curve values, differences were significant between i) and iii) (p<0.0001) and between ii) and iii) (p<0.0001). CONCLUSION: The present study is the first to provide evidence suggesting that the DS can be used for clinical confirmation of ARCO in patients with AAP, with a high diagnostic accuracy without radiological or laboratory analyses.
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Dolor Abdominal/complicaciones , Cólico Renal/diagnóstico , Enfermedad Aguda , Adulto , Estudios de Cohortes , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cólico Renal/complicacionesRESUMEN
OBJETIVO: Evaluar una vía de alta resolución (vía POC) que utiliza análisis en el punto de atención (point-of-care testing-POCT-) y ecografía en el punto de atención (point-of-care ultrasonography -POCUS-) en la sospecha del cólico renoureteral (CRU) no complicado y compararla con la vía estándar (vía STD). MÉTODO: Ensayo clínico aleatorizado, controlado, no ciego, realizado en un servicio de urgencias hospitalario (SUH). Incluyó pacientes con sospecha clínica de CRU agudo y se aleatorizaron 1:1 a seguir vía POC o vía STD. Se analizó el tiempo de estancia en el SUH, el tratamiento administrado, la proporción de diagnósticos alternativos a CRU y las complicaciones a 30 días. RESULTADOS: Entre noviembre de 2018 y octubre de 2019, se reclutaron 140 pacientes de los que se analizaron 124.El tiempo de estancia total en el SUH de la vía POC fue de 112 minutos (DE 45) y en la vía STD 244 minutos (DE102) (p < 0,001). No hubo diferencias en el tratamiento administrado en urgencias, en el número de diagnósticos alternativos, ni en las complicaciones a 30 días. CONCLUSIONES: La utilización de una vía de alta resolución del manejo del CRU en un SUH es eficaz, segura y reduce el tiempo de estancia en urgencias
OBJECTIVES: To evaluate a fast-track pathway utilizing point-of-care (POC) testing and sonography as soon as uncomplicated renal or ureteral colic is suspected and to compare the POC clinical pathway to a standard one. METHODS: Unblinded randomized controlled clinical trial in a hospital emergency department (ED). We enrolled patients with suspected uncomplicated renal or ureteral colic and randomized them to a POC or standard pathway(1:1 ratio). Duration of ED stay, treatments, the proportion of diagnoses other than uncomplicated colic, and 30-daycomplications were analyzed. RESULTS: One hundred forty patients were recruited between November 2018 and October 2019; data for 124 were analyzed. The mean (SD) total time in the ED was 112 (45) minutes in the POC arm and 244 (102) in the standard arm (P< .001). Treatments, alternative diagnoses, and complication rates did not differ. CONCLUSION: The use of a fast-track POC pathway to manage uncomplicated colic in the ED is effective and safe. It also reduces the amount of time spent in the ED
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Cólico Renal/diagnóstico , Sistemas de Atención de Punto/organización & administración , Pruebas en el Punto de Atención/organización & administración , Vías Clínicas/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Tratamiento de Urgencia/métodos , Atención de Enfermería/métodos , Planificación de Atención al Paciente/organización & administraciónRESUMEN
OBJECTIVES: To evaluate a fast-track pathway utilizing point-of-care (POC) testing and sonography as soon as uncomplicated renal or ureteral colic is suspected and to compare the POC clinical pathway to a standard one. MATERIAL AND METHODS: Unblinded randomized controlled clinical trial in a hospital emergency department (ED). We enrolled patients with suspected uncomplicated renal or ureteral colic and randomized them to a POC or standard pathway (1:1 ratio). Duration of ED stay, treatments, the proportion of diagnoses other than uncomplicated colic, and 30-day complications were analyzed. RESULTS: One hundred forty patients were recruited between November 2018 and October 2019; data for 124 were analyzed. The mean (SD) total time in the ED was 112 (45) minutes in the POC arm and 244 (102) in the standard arm (P .001). Treatments, alternative diagnoses, and complication rates did not differ. CONCLUSION: The use of a fast-track POC pathway to manage uncomplicated colic in the ED is effective and safe. It also reduces the amount of time spent in the ED.
OBJETIVO: Evaluar una vía de alta resolución (vía POC) que utiliza análisis en el punto de atención (point-of-care testing POCT) y ecografía en el punto de atención (point-of-care ultrasonography POCUS) en la sospecha del cólico renoureteral (CRU) no complicado y compararla con la vía estándar (vía STD). METODO: Ensayo clínico aleatorizado, controlado, no ciego, realizado en un servicio de urgencias hospitalario (SUH). Incluyó pacientes con sospecha clínica de CRU agudo y se aleatorizaron 1:1 a seguir vía POC o vía STD. Se analizó el tiempo de estancia en el SUH, el tratamiento administrado, la proporción de diagnósticos alternativos a CRU y las complicaciones a 30 días. RESULTADOS: Entre noviembre de 2018 y octubre de 2019, se reclutaron 140 pacientes de los que se analizaron 124. El tiempo de estancia total en el SUH de la vía POC fue de 112 minutos (DE 45) y en la vía STD 244 minutos (DE 102) (p 0,001). No hubo diferencias en el tratamiento administrado en urgencias, en el número de diagnósticos alternativos, ni en las complicaciones a 30 días. CONCLUSIONES: La utilización de una vía de alta resolución del manejo del CRU en un SUH es eficaz, segura y reduce el tiempo de estancia en urgencias.