SGEM XTRA - December 28, 2019 - By admin
"CLINICAL QUESTION: FOR PATIENTS PRESENTING TO THE ED WITH PAIN SUSPECTED TO BE UNCOMPLICATED RENAL COLIC, WHAT IMAGING SHOULD BE PURSUED COMPARED WITH STANDARD NONCONTRAST CT SCANNING TO OPTIMIZE PATIENT-CENTERED OUTCOMES?
FIVE MAJOR THEMES
- Younger Patients (~35 years old): Even without a history of stones, CT may be avoided as long as pain is controlled (perfect consensus).
- Middle-Aged Patients (~55 years old): We recommend CT if there is no history of kidney stones.
- Older Patients (~75 years old): We recommend CT regardless of history.
- Pregnant and Pediatric Patients: With a typical presentation they should undergo ultrasonography and do not require initial CT if symptoms are relieved.
- Radiation Dose: We recommend reduced-radiation-dose CT whenever CT is used for suspected renal colic.
Were there any limitations you identified?
There are many more 29 clinical scenarios. We chose this number because it seemed to be the best balance of major factors with the least number of scenarios. The scenarios are also skewed toward those in which the clinical likelihood of a kidney stone is high according to objective criteria. Although we did include scenarios with stone being less likely and found that in these scenarios practitioners were more likely to request CT, there may have been a bias toward assuming these scenarios represented kidney stone and no other diagnosis."