Emergency Department Ultrasound in Renal Colic

Study Overview
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Brief Summary
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Renal colic is a common (1300 visits per year at our institution) and painful condition caused by stones in the kidney and ureter, and can be mimicked by life threatening conditions such as a ruptured abdominal aortic aneurysm (AAA). This can create clinical uncertainty. Emergency department targeted ultrasound (EDTU) is performed by an emergency physician at the patient's bedside, and has been shown to be accurate, safe, and efficient. We have shown that EDTU can accurately identify hydronephrosis, which is a predictor of complications of kidney stones. A normal formal ultrasound (US) predicts an uncomplicated clinical course. We will assess the accuracy of EDTU for the diagnosis of hydronephrosis, and when normal, whether patients can be safely discharged.

Official Title
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Hydro II: Emergency Department Ultrasound in Renal Colic

Conditions
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Renal Colic, Hydronephrosis, Abdominal Aortic Aneurysm

Intervention / Treatment
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* Procedure: EDTU


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 16 - 65 years Symptoms suggestive of renal colic EDTU performed within one hour (before or after) of formal imaging Imaging study arranged during this ED visit (includes next morning) Exclusion Criteria: Hemodynamic instability (Pulse > 120 or SBP < 90 or requiring vasopressors) Fever (>38 degrees C) Leukocytes and nitrites on dipstick urinalysis (evidence of urinary tract infection) Pregnancy Inmate Renal transplant or single functioning kidney

Ages Eligible for Study
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Minimum Age: 16 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| rule in renal colic<br>ED patients with abdominal/flank pain where a diagnosis of renal colic is being considered and undergoing formal imaging while in the ED | Procedure: EDTU<br>* bedside ultrasound imaging by the treating emergency physician<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| complications post-ED visit in patients with and without negative EDTU. | The frequency of complications by 30 days post-ED visit in patients with and without negative EDTU. | 30 days | 
| diagnostic accuracy for hydronephrosis | The accuracy of ED physicians in using EDTU to assess for hydronephrosis when compared to diagnostic imaging by CT or formal ultrasound. | 1 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ED length of stay | estimates of potential time of ED stay saved if a clinical decision is made on the basis of an EDTU (rather than waiting for formal diagnostic imaging) | 1 day | 
| radiation dose | potential savings in radiation exposure from avoiding CT scanning | 1 hour | 
| accuracy in ruling out AAA | accuracy of ED physicians in using EDTU to assess aortic size (and rule out AAA) when compared to diagnostic imaging by CT or formal ultrasound will also be validated. | 1 hour | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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renal colic, hydronephrosis, abdominal aortic aneurysm, ultrasound, emergency medicine, urolithiasis