Imaging in Suspected Renal Colic: Systematic Review of the Literature and Multispecialty Consensus.

Moore CL1, Carpenter CR2, Heilbrun ME3, Klauer K4, Krambeck AC5, Moreno C3, Remer EM6, Scales C7, Shaw MM8, Sternberg KM9.

Author information

1: Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut. Electronic address: Chris.moore@yale.edu.
2: Department of Emergency Medicine, Washington University in Saint Louis, Saint Louis, Missouri.
3: Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
4: Emergency Medicine, University of Tennessee, Chattanooga, Tennessee; Department of Family Medicine, University of Tennessee, Knoxville, Tennessee; Department of Osteopathic Specialties, Michigan State University, East Lansing, Michigan.
5: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
6: Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
7: Duke Clinical Research Institute and Department of Surgery (Urology), Duke University School of Medicine, Durham, North Carolina.
8: Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut.
9: Department of Urology, University of Vermont Medical Center, Burlington, Vermont.

Abstract

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%).

SUMMARY:

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.

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. Published by Elsevier Inc. All rights reserved.