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(596) Is There a Role for Abdominal Plain Films in Patients Suspected of Having Renal Colic?


Authors:

Daniel Johnson, n/a

Sean Calhoun, n/a – Morristown Medical Center

Barney Eskin, MD, PhD – Faculty, Morristown Memorial Hospital

John Allegra, MD, PhD – Faculty, Morristown Medical Center

Barney Eskin, MD, PhD – Faculty, Morristown Memorial Hospital

Abstract:

Background and Objectives: Renal colic is often very painful, but rarely dangerous. For most patients, making the diagnosis of renal colic “rules out” other potentially dangerous diseases such as aortic aneurysm and appendicitis. Non-contrast computed tomography (NCCT) has been touted as the best radiology test for renal colic, but has high cost and radiation exposure. The abdominal Xray (KUB) together with renal ultrasound has been proposed as an alternative to NCCT. We sought to determine whether the KUB alone could reduce NCCT testing.

Methods: Study Design: Retrospective cohort. Population: 1000 consecutive patients from 7-1-17 to 12-31-17 who received a NCCT at a suburban community teaching hospital with annual ED visits of 90,000. As per the hospital radiology “renal stone protocol.”, when a NCCT is ordered for suspected renal colic, a KUB is obtained automatically. (NCCTs may also be done for other reasons.) We randomly sorted 1000 records of NCCTs and arbitrarily stopped after examining 188; 74 of these had no KUB, leaving 114 for further analysis. The KUBs and NCCTs were initially interpreted together by attending radiologists. One of the radiologists re-read the 114 KUBs without knowledge of the NCCT results and reported each KUB as being positive, negative or indeterminate for ureteral stones (the latter usually because of problems distinguishing stones from phleboliths). We calculated sensitivities, specificities and likelihood ratios (LRs) and their 95% confidence intervals (CIs) for the diagnosis of urolithiasis for the KUB, using the NCCT as the criterion standard.

Results: The median age was 52 years (interquartile range: 41, 61); 54% were female. Fifty-one (45%) had a positive NCCT and 34 (30%) had a positive KUB. Using the NCCT as the criterion standard, the number of true positives, true negatives, false negatives and false positives for the KUB were 34, 63, 17 and 0, respectively. The sensitivity and specificity of the KUB for urolithiasis were 67% (95% CI 52, 79%) and 100% (95% CI 93, 100%), respectively. The LRs associated with a negative and positive KUB were 0.33 (95% CI: 0.23, 0.49) and infinity (95% CI: 14, infinity), respectively.

Conclusion: The specificity and the positive LR for the KUB are high, so when the KUB is “positive” the diagnosis is almost certainly renal colic. Since 30% of the patients had a positive KUB, using the KUB as the initial test could reduce NCCTs by 30%.

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