Does diagnosis change as a result of repeat renal colic computed tomography scan in patients with a history of kidney stones?
Received 13 September 2008; received in revised form 26 November 2008; accepted 28 November 2008. published online 26 October 2009.
Abstract
Study objective
We sought to determine the incidence of alternative diagnosis in patients with a history of kidney stones who experience recurrent symptoms and undergo repeat computed tomography (CT) imaging at their return to the emergency department (ED).
Methods
This was a retrospective chart review of ED patients at a tertiary care hospital. Inclusion criteria were all adult ED patients who received a repeat CT for renal colic, after having previously received the diagnosis of obstructive kidney stone confirmed by CT, in our ED. Patients were identified by reviewing the charts of those patients with repeat visits to the ED after January 1, 2004, in which they complained of symptoms suggestive of renal colic and received a CT scan. We determined the frequency of the same diagnosis on repeat CT scan in this population compared with the frequency of alternative diagnosis.
Results
Two hundred thirty-one patients met criteria for the study. Fifty-nine percent were male. One hundred eighty-nine (81.8%) patients had no change in diagnosis as a result of a repeat renal colic CT scan. Twenty-seven (11.6%) patients received an alternative diagnosis that did not require urgent intervention, and 15 (6.5%) patients received a diagnosis that did require an urgent intervention.
Conclusion
Repeat CT imaging of patients with known nephrolithiasis changed management in a minority of patients (6.5%). Knowing the frequency of alternative diagnosis in this population may help clinicians and patients balance the risks and benefits of repeat renal colic CT scans in patients with a history of kidney stones who return to the ED with similar symptoms.
aUniversity of Vermont College of Medicine, Burlington, VT 05405, USA
bDepartment of Emergency Medicine, North Shore University Hospital, Manhasset, NY 11030, USA
cDivision of Emergency Medicine, Department of Surgery, University of Vermont College of Medicine, Burlington, VT 05401, USA
Corresponding author. North Shore University Hospital, Department of Emergency Medicine, 300 Community Drive, Manhasset, NY 11030, USA. Tel.: +1 301 785 4531.
ABSTRACT