March 2015 Ultrasound for Renal Colic

This month JC is looking at the utility of ultrasound as an initial diagnostic imaging modality in patients suspected of having acute renal colic. There has been a sustained increase in the number of CT’s ordered for those with clinical evidence of renal colic despite evidence of harm from radiation exposure in younger patients. Currently, ultrasound is utilized in less than 10% of ED patients suspected of having renal colic. This is in stark contrast to our colleagues in Canada where ultrasound is the primary imaging modality in 70% of ED patients undergoing imaging for suspected renal colic. There has been some recent data including an RCT included below that suggests the possibility of an increased role for ultrasound as the primary imaging modality when evaluating ED patients with suspected renal colic. Also included is the latest Appropriateness Criteria article by the ACR regarding radiologic diagnosis of those suspected of having renal colic.

P: In ED patients with evidence of acute renal colic

I: Does the use of renal ultrasound

C: Compared to routine non-contrast CT

O: Provide clinically acceptable diagnostic accuracy 

 Smith-Bindman R, et al. Ultrasonography versus computed tomography for suspected nephrolithiasis.  N Engl J Med. 2014 Sep 18;371(12):1100-10

Herbst M et al. Effect of provider experience on clinician-performed ultrasonography for hydronephrosis in patients with suspected renal colic. Ann Emerg Med. 2014 Sep;64(3):269-76.

Edmonds ML et al. The utility of renal ultrasonography in the diagnosis of renal colic in emergency department patients. CJEM. 2010 May;12(3):201-6.

Coursey CA, ACR Appropriateness Criteria® acute onset flank pain--suspicion of stone disease. Ultrasound Q. 2012 Sep;28(3):227-33. Review