Category: Epidemiology, Health Policy, Socioeconomics & Outcomes
Introduction & Objective : There is lack of objective measurement that define the need for emergency intervention (EI) for acute renal colic secondary to ureteric stones. This study was conducted to develop a scoring system for the need of EI among these patients.
From May 2017 through April 2018, all consecutive patients who presented with acute renal colic to emergency department (ED) were prospectively assessed. Inclusion criteria were adult patients with ureteric stones confirmed by non-contrast CT. Patients with solitary kidney or history of urolithiasis treatment within the past 6 months were excluded. EI was performed in cases with persistent pain (in spite of opioids), repeated visits to ED for recurrent pain or complications secondary to obstruction. Univariate and multivariate analyses were performed to detect risk factors for EI. The cutoff value of each significant factor was calculated with ROC curve, and then was utilized to develop the score. Sensitivity and specificity of the score were calculated using ROC curve.
Results : The study included 200 patients (mean age 44.2 years). EI was performed in 119 (ureteric stents in 90, ureteroscopy in 25 and percutaneous nephrostomy in 4). Table 1 summarizes univariate analysis. Significant factors on multivariate analysis were stone location (P=0.026, 95%CI: 1.16-10.16), creatinine level (P Each patient got a score from 4-8. EI was required for no patients with score 4, 28% for score 5, 71% for 6, 96% for 7 and 100% for score 8. Score sensitivity was 86%, specificity was 80% and AUC was 0.902 (figure 1).
Conclusions : This novel score was proved to be highly sensitive and specific to determine the need for EI in patients with acute renal colic secondary to ureteric stones.
Abdullatif Al-Terki– Consultant in Urology, Amiri Hospital, Kuwait, Hawalli, Kuwait
Ahmed R. EL-Nahas– Consultant in Urology, Amiri Hospital, Mansoura, Ad Daqahliyah, Egypt
Mohamed Al-Ruwaished– Resident in Urology, Amiri Hospital, Kuwait, Al Asimah, Kuwait
Yaqoub Alqattan– Resident in Urology, Amiri Hospital, Kuwait, Al Asimah, Kuwait
Usama Abdelhamid– Registrar in urology, Amiri Hospital, Kuwait, Al Asimah, Kuwait
Tariq Al-Shaiji– Consultant in Urology, Amiri Hospital, Kuwait, Al Asimah, Kuwait