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| Dr Gabriel Blecher |
Monash University researchers have shown the benefit of new
imaging guidelines for patients with suspected kidney stones.
Led by Monash Health emergency physician Dr Gabriel Blecher,
the study, published in the Emergency Medicine Journal, analysed the use
of focused ultrasound rather than CT urography (CTU) for diagnosing patients
with renal colic.
A condition commonly managed in emergency departments, renal
colic presents as severe abdominal pain and is usually caused by kidney stones.
Urinary stone disease in increasingly prevalent, occurring
in 12% of men and 6% of women. The age of onset of a first stone episode for
men rises from the 20s and peaks at age 40-60 years, with an incidence of three
cases per 1000 population per year.
Dr Blecher, a member of the Monash Emergency Research
Collaborative (MERC), School of Clinical Sciences at Monash Health (SCS) said
that although acute symptoms of renal colic can be severe, the subsequent
course of action is usually benign, with up to 80% of kidney stones passing
spontaneously.
“In the last decade, CT use has become widespread in
suspected renal colic, without any improvement in patient outcomes,” Dr Blecher
said.
“The associated harms of CT include over-diagnosis,
radiation exposure and waste of hospital resources.”
Despite a documented 12-fold increase in CTU utilisation for
suspected renal colic in recent years, diagnostic rates and the number
requiring operative intervention have not changed.
In the study, Monash Health Emergency patients presenting
with suspected renal colic were enrolled to the new focused ultrasound intervention
at one site and their outcomes were compared with patients using existing CTU
guidelines at another site.
“We found that using a simple assessment guideline for
suspected renal colic led to a 21% lower CTU rate compared with the control
site,” Dr Blecher said.
“Our new protocol favours focussed ultrasound performed by
the emergency doctor rather than CT scanning in radiology , which is currently
performed in about 75% of cases.”
“Our intervention group underwent CT scans in only 54% of
cases, lowering the median radiation doses to 2.8mSv compared with the control
group at 4.0mSv.”
Dr Blecher said benefits of the new guidelines include
faster diagnosis and less radiation dose—and this is important as most patients
with renal colic are young.
“Our findings will also lead to significant cost savings by
performing fewer CT scans,” Dr Blecher said.
