Emergency Department Ultrasound in Renal Colic

Hydro II: Emergency Department Ultrasound in Renal Colic

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.

Study Overview

• Status: Completed
• Conditions: Renal Colic; Hydronephrosis; Abdominal Aortic Aneurysm
• Intervention / Treatment: Procedure: EDTU

• Study Type: Observational
• Enrollment (Actual): 414

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Kingston, Ontario, Canada, K7L 2V7
      • Kingston General Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 65 years (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

ED patients with suspected renal colic being imaged while in the ED

Description

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

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
rule in renal colic; 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; bedside ultrasound imaging by the treating emergency physician

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: Queen's University
• Collaborators: Ontario Ministry of Health and Long Term Care
• Investigators: Principal Investigator: Eric Bruder, MD, Queen's University

Publications and helpful links

General Publications

• Sibley S, Roth N, Scott C, Rang L, White H, Sivilotti MLA, Bruder E. Point-of-care ultrasound for the detection of hydronephrosis in emergency department patients with suspected renal colic. Ultrasound J. 2020 Jun 8;12(1):31. doi: 10.1186/s13089-020-00178-3.

Study record dates

Study Major Dates

• Study Start: March 1, 2011
• Primary Completion (Actual): July 1, 2013
• Study Completion (Actual): December 1, 2013

Study Registration Dates

• First Submitted: March 24, 2011
• First Submitted That Met QC Criteria: March 24, 2011
• First Posted (Estimate): March 28, 2011

Study Record Updates

• Last Update Posted (Estimate): November 26, 2015
• Last Update Submitted That Met QC Criteria: November 24, 2015
• Last Verified: November 1, 2015

More Information

Terms related to this study

• Keywords: ultrasound; hydronephrosis; urolithiasis; emergency medicine; renal colic; abdominal aortic aneurysm
• Additional Relevant MeSH Terms: Pathologic Processes; Cardiovascular Diseases; Vascular Diseases; Kidney Diseases; Urologic Diseases; Pain; Neurologic Manifestations; Disease Attributes; Infant, Newborn, Diseases; Aortic Diseases; Renal Colic; Emergencies; Colic; Aneurysm; Aortic Aneurysm; Aortic Aneurysm, Abdominal; Hydronephrosis
• Other Study ID Numbers: Hydro II