EFFECTIVENESS OF BEDSİDE EMERGENCY ULTRASONOGRAPHY IN PATIENTS WITH RENAL COLIC PRESENTING TO THE EMERGENCY DEPARTMENT

Abstract

Objective: This study aimed to evaluate the diagnostic performance of point-of-care ultrasound (POCUS) for detecting and grading hydronephrosis in patients presenting to the emergency department (ED) with suspected renal colic, using non-contrast computed tomography (CT) as the reference standard. Material and Methods: This prospective observational diagnostic accuracy study included 106 adult patients who underwent both renal POCUS and non-contrast CT during the same ED visit. Hydronephrosis was classified as none, mild, moderate, or severe. The diagnostic performance of POCUS was assessed for detecting any hydronephrosis (grade ≥2) and moderate-to-severe hydronephrosis (grade ≥3). Agreement between POCUS and CT grading was evaluated using kappa coefficients.
Results: CT demonstrated hydronephrosis in 58 patients (54.7%). For any hydronephrosis, POCUS showed a sensitivity of 86.2%, specificity of 83.3%, and overall accuracy of 84.9% (κ=0.695; p<0.001). Exact agreement across the four grades was 62.3%, while within-one-grade agreement was 98.1%. Linear-weighted and quadratic-weighted κ values were 0.626 and 0.777, respectively. POCUS assigned a higher grade than CT in 30 cases and a lower grade in 10 cases (p=0.001). For moderate-to-severe hydronephrosis, sensitivity was 88.9%, specificity was 82.3%, and negative predictive value was 95.6%.
Conclusion:  POCUS provides good diagnostic performance for the rapid, radiation-free assessment of hydronephrosis in renal colic. However, because it tends to overestimate hydronephrosis severity compared with CT, high-grade POCUS findings should not be considered directly equivalent to the corresponding CT grade.

Keywords

• Renal Colic
• Hydronephrosis
• Point-of-Care Ultrasound
• Computed Tomography
• Emergency Department

Supporting Institution

none

Project Number

yok

Ethical Statement

Ethical approval was obtained from the Yozgat Bozok University Non-Interventional Clinical Research Ethics Committee (approval no: 2017-KAEK-189_2019.01.09_05) before participant enrollment.

Thanks

none

Acil Servise Başvuran Renal Kolikli Hastalarda Yatakbaşı Acil Ultrasonografinin Etkinliği

Abstract

Amaç: Bu çalışmada, acil servise (AS) renal kolik şüphesiyle başvuran hastalarda yatak başı ultrasonografinin 
(POCUS) hidronefrozun saptanması ve derecelendirilmesindeki tanısal performansının, kontrastsız bilgisayarlı tomografi (BT) referans alınarak değerlendirilmesi amaçlandı.
Gereç ve Yöntemler: Bu prospektif gözlemsel tanısal doğruluk çalışmasına, aynı AS başvurusu sırasında renal POCUS ve kontrastsız BT uygulanan 106 erişkin hasta dahil edildi. Hidronefroz yok, hafif, orta ve şiddetli olmak üzere dört düzeyde derecelendirildi. POCUS’un herhangi bir hidronefrozu (derece ≥2) ve orta-şiddetli hidronefrozu (derece ≥3) saptamadaki tanısal performansı değerlendirildi. POCUS ile BT arasındaki derecelendirme uyumu kappa katsayılarıyla analiz edildi.
Bulgular:  BT’de 58 hastada (%54,7) hidronefroz saptandı. POCUS’un herhangi bir hidronefroz için duyarlılığı %86,2, özgüllüğü %83,3 ve doğruluğu %84,9 idi (κ=0,695; p<0,001). Dört düzeyli derecelendirmede tam uyum %62,3, bir derece içinde uyum %98,1 bulundu. Lineer ve kuadratik ağırlıklı κ değerleri sırasıyla 0,626 ve 0,777 idi. POCUS, 30 olguda BT’den daha yüksek, 10 olguda daha düşük derece belirledi (p=0,001). Orta-şiddetli hidronefroz için duyarlılık %88,9, özgüllük %82,3 ve negatif prediktif değer %95,6 idi.
Sonuç: POCUS, renal kolikte hidronefrozun hızlı ve radyasyonsuz değerlendirilmesinde iyi tanısal performans göstermektedir. Ancak hidronefroz derecesini BT’ye göre daha yüksek sınıflandırma eğiliminde olduğundan, yüksek dereceli POCUS bulguları BT ile doğrudan eşdeğer kabul edilmemelidir.
 

Keywords

• Renal Kolik
• Hidronefroz
• Yatak Başı Ultrasonografi
• Bilgisayarlı Tomografi
• Acil Servis

Supporting Institution

yok

Project Number

yok

Ethical Statement

Ethical approval was obtained from the Yozgat Bozok University Non-Interventional Clinical Research Ethics Committee (approval no: 2017-KAEK-189_2019.01.09_05) before participant enrollment.

Thanks

yok

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