Risk Stratification for Hospital Admission in Emergency Department Patients with Renal Colic

Abstract

Objective: Renal colic pain is a common urological emergency and a frequent reason for emergency department visits. Early diagnosis of patients at high risk of hospitalization is important to improve clinical decision-making processes and optimize emergency department resources. This study aimed to evaluate the clinical, laboratory, and radiological determinants of hospitalization and interventional treatment in patients presenting to the emergency department with renal colic pain. Methods: This retrospective observational study included adult patients presenting to the emergency department with renal colic pain due to ureteral stones, confirmed by computed tomography, between January 2025 and January 2026. Of 1074 patients diagnosed with renal colic pain, 719 met the inclusion criteria. Demographic, laboratory, and radiological variables, including stone size, stone location, and degree of hydronephrosis, were analyzed. Determinants of hospitalization were assessed using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) analysis was performed to evaluate the discriminative performance of key variables, and an internal clinical risk model was developed. Results: Of 719 patients, 293 (40.8%) required hospitalization, and 253 (86.3%) underwent urological surgery. Larger stone size, proximal ureteral stone location, higher degree of hydronephrosis, elevated serum leukocyte and CRP levels, and increased urinary leukocytes were identified as independent predictors of hospitalization. ROC analysis showed the highest predictive performance for serum leukocytes (AUC 0.971), followed by stone size (AUC 0.895) and CRP (AUC 0.890). The clinical risk model showed excellent predictive performance (AUC 0.996). Conclusion: Stone size, proximal stone location, severity of hydronephrosis, and inflammatory markers are significant predictors of hospitalization in patients with renal colic. The proposed risk model can aid in early risk stratification, but external validation is needed before routine clinical use.

Keywords

• Emergency
• Hospitalization
• Renal colic
• Ureteral stone
• Urological emergency

Supporting Institution

Erzurum Medicine Faculty University Local Ethics Committee

Ethical Statement

This study was approved by the Erzurum Medicine Faculty University Local Ethics Committee (approval number: BAEK 2026/02-94).

Thanks

NONE

Böbrek Kolik Ağrısı Olan Acil Servis Hastalarında Hastaneye Yatış İçin Risk Sınıflandırması

Abstract

Amaç: Böbrek kolik ağrısı sık görülen bir ürolojik acil durum olup acil servis ziyaretlerinin sıkça nedenlerinden biridir. Hastaneye yatış riski yüksek olan hastaların erken teşhisi, klinik karar verme süreçlerini iyileştirmek ve acil servis kaynaklarını optimize etmek için önemlidir. Bu çalışma, acil servise böbrek kolik ağrısı ile başvuran hastalarda hastaneye yatış ve girişimsel tedavinin klinik, laboratuvar ve radyolojik belirleyicilerini değerlendirmeyi amaçlamıştır. Yöntemler: Bu retrospektif gözlemsel çalışma, Ocak 2025 ile Ocak 2026 tarihleri ​​arasında bilgisayar tomografisi ile doğrulanan üreter taşlarına bağlı böbrek kolik ağrısı nedeniyle acil servise başvuran yetişkin hastaları içermiştir. Böbrek kolik ağrısı tanısı konulan 1074 hastadan 719'u dahil edilme kriterlerini karşılamıştır. Taş boyutu, taş yeri ve hidronefroz derecesi dahil olmak üzere demografik, laboratuvar ve radyolojik değişkenler analiz edilmiştir. Hastaneye yatışın belirleyicileri, tek değişkenli ve çok değişkenli lojistik regresyon analizleri kullanılarak değerlendirilmiştir. Anahtar değişkenlerin ayırt edici performansını değerlendirmek için alıcı işletim karakteristik (ROC) analizi yapıldı ve dahili bir klinik risk modeli geliştirildi. Sonuçlar: 719 hastanın 293'ü (%40,8) hastaneye yatırılmayı gerektirdi ve 253'ü (%86,3) ürolojik cerrahi geçirdi. Daha büyük taş boyutu, proksimal üreter taş yerleşimi, daha yüksek hidronefroz derecesi, yüksek serum lökosit ve CRP seviyeleri ve artmış idrar lökositleri, hastaneye yatışın bağımsız öngörücüleri olarak tanımlandı. ROC analizi, serum lökositleri için en yüksek tahmin performansını (AUC 0,971), ardından taş boyutu (AUC 0,895) ve CRP'yi (AUC 0,890) gösterdi. Klinik risk modeli mükemmel tahmin performansı gösterdi (AUC 0,996). Sonuç: Taş boyutu, proksimal taş yerleşimi, hidronefrozun şiddeti ve inflamatuar belirteçler, renal kolikli hastalarda hastaneye yatışın önemli öngörücüleridir. Önerilen risk modeli, erken risk sınıflandırmasına yardımcı olabilir, ancak rutin klinik kullanımdan önce harici doğrulama gereklidir.

Keywords

• Acil durum
• Hastaneye yatış
• Renal kolik
• Üreter taşı
• Ürolojik acil durum

Supporting Institution

Erzurum Tıp Fakültesi Üniversitesi Yerel Etik Kurulu

Ethical Statement

Bu çalışma, Erzurum Tıp Fakültesi Üniversitesi Yerel Etik Kurulu tarafından onaylanmıştır (onay numarası: BAEK 2026/02-94).

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