A recent study published in the Canadian Journal of Emergency Medicine (CJEM) indicates that the use of renal point-of-care ultrasound (PoCUS) by emergency department (ED) staff with limited training can predict the need for urological procedures within 30 days among patients with renal colic. The findings suggest that renal PoCUS may be an effective tool for non-specialized ED practitioners after a brief training session to assess hydronephrosis, potentially influencing patient’s management and outcomes.

Study Background

The study, carried out at Ng Teng Fong General Hospital in Singapore, aimed to determine how effectively ED staff without accreditation in PoCUS could use the tool to manage patients with renal colic, particularly in less resourced EDs. Behavioral outcomes were correlated with the presence of hydronephrosis as diagnosed by PoCUS, conducted by non-ED specialist/resident physicians upon receiving a 3.5-hour training from PoCUS accredited attendings.

Methodology and Outcomes

The single-centre review involved adult ED patients presenting with renal colic from July to December 2023. A simple distinction between the presence and absence of hydronephrosis by PoCUS was used to guide future management. The primary outcome analyzed was the requirement of urological procedures within 30 days. Secondary outcomes included the recurrence of nephrolithiasis-related ED visits within the same timeframe and the association between the grade of hydronephrosis and these outcomes.

Key Findings

Out of the 651 patients included in the study, 491 (75.4%) were found to have hydronephrosis. The rate of urological procedures required within 30 days was significantly higher in patients with hydronephrosis (11.2%) compared to those without (2.5%), with a corresponding crude odds ratio (COR) of 4.9. Additionally, a greater grade of hydronephrosis correlated with an increased rate of urological interventions.

Interestingly, there were no significant differences in the rate of 30-day nephrolithiasis-related ED revisits when comparing patients with and without hydronephrosis.

Implications and Conclusion

This study’s outcomes suggest that non-specialist ED staff, post brief training, can effectively use renal PoCUS to identify patients unlikely to require urological intervention and those who might benefit from more intensive risk stratification based on the severity of hydronephrosis. Furthermore, it could support the streamlining of patient care through early and accurate diagnosis, potentially reducing unnecessary urological procedures and optimizing resource utilization within the healthcare system.

Under the guidance of senior ED staff, junior resident doctors learned to perform and interpret renal PoCUS to make time-sensitive decisions regarding the management of renal colic. This could improve patient outcomes while adapting to the constraints of under-resourced emergency departments.

The study showcases an accessible mode of training and deployment of PoCUS in resource-limited settings, thereby highlighting the adaptability and utility of PoCUS in various clinical environments.

Future Directions

Further research is advocated to explore the potential of renal PoCUS in different clinical settings and its long-term impact on patient care and healthcare resources. Furthermore, studies to evaluate the cost-effectiveness and patient satisfaction associated with PoCUS in renal colic would also provide valuable insights.

References

The study reported in this news article can be referenced using the following DOI: 10.1007/s43678-023-00645-5. Below are additional references that provide context and support the information detailed in the article:

1. Patti, L., & Leslie, S. W. (2022). Acute renal colic. StatPearls Publishing.
2. Coursey, C. A., Casalino, D. D., Remer, E. M., Arellano, R. S., Bishoff, J. T., Dighe, M., et al. (2012). ACR appropriateness criteria® acute onset flank pain–suspicion of stone disease. Ultrasound Q, 28(3), 227–233. DOI: 10.1097/RUQ.0b013e3182625974
3. Gaspari, R. J., & Horst, K. (2005). Emergency ultrasound and urinalysis in the evaluation of flank pain. Acad Emerg Med, 12(12), 1180–1184. DOI: 10.1197/j.aem.2005.06.023
4. Wong, C., Teitge, B., Ross, M., Young, P., Robertson, H. L., & Lang, E. (2018). The accuracy and prognostic value of point-of-care ultrasound for nephrolithiasis in the Emergency Department: a systematic review and meta-analysis. Acad Emerg Med, 25(6), 684–698. DOI: 10.1111/acem.13388
5. Taylor, M., Woo, M. Y., Pageau, P., McInnes, M. D., Watterson, J., Thompson, J., et al. (2016). Ultrasonography for the prediction of urological surgical intervention in patients with renal colic. Emerg Med J, 33(2), 118–123. DOI: 10.1136/emermed-2014-204524

Keywords

1. Renal PoCUS Emergency Department
2. PoCUS Training for ED Staff
3. Renal Colic Management
4. Hydronephrosis Ultrasound Detection
5. Urological Procedures and PoCUS

The article sheds light on the practical application of PoCUS in renal colic and provides evidence to reinforce the role of this technology in reducing the burden on healthcare systems by facilitating early and accurate detection that may prevent unnecessary medical procedures.