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

Öz

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.

Anahtar Kelimeler

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

Destekleyen Kurum

none

Proje Numarası

yok

Etik Beyan

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.

Teşekkür

none

Acil Servise Başvuran Renal Kolikli Hastalarda Yatakbaşı Acil Ultrasonografinin Etkinliği

Öz

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.
 

Anahtar Kelimeler

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

Destekleyen Kurum

yok

Proje Numarası

yok

Etik Beyan

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.

Teşekkür

yok

Kaynakça

1. Teichman JM. Clinical practice. Acute renal colic from ureteral calculus. N Engl J Med. 2004;350(7):684-93.
2. Coursey CA, Casalino DD, Remer EM, Arellano RS, Bishoff JT, Dighe M, et al. ACR Appropriateness Criteria® acute onset flank pain--suspicion of stone disease. Ultrasound Q 2012; 28(3):227-33.
3. Westphalen AC, Hsia RY, Maselli JH, Wang R, Gonzales R. Radiological imaging of patients with suspected urinary tract stones: national trends, diagnoses, and predictors. Acad Emerg Med. 2011;18(7):699-707.
4. Smith-Bindman R, Aubin C, Bailitz J, Bengiamin RN, Camargo CA, Jr Corbo J, et al. Ultrasonography versus computed tomography for suspected nephrolithiasis. N Engl J Med. 2014;371(12):1100-10.
5. Kim SG, Jo IJ, Kim T, Hwang SY, Park JH, Shin TG, et al. Usefulness of protocolized point-of-care ultrasonography for patients with acute renal colic who visited emergency department: A randomized controlled study. Medicina, 2019;55(11):717.
6. Lee WF, Goh SJ, Lee B, Juan SJ, Asinas-Tan M, Lim B. L. Renal point-of-care ultrasound performed by ED staff with limited training and 30-day outcomes in patients with renal colic. CJEM. (2024); 26(3):198-203.
7. Scheatzle MD, Johnjulio W, Li J, Lieurance R, O’Neill J,McGahan, M. Renal point-of-care ultrasound findings and downstream computed tomography use, urologic intervention, and emergency department length of stay in renal colic. J Emerg Med. 2026;86:101-9.
8. Griveau B, Papin M, Thibaud C, Mordant C, Berranger C, Montassier E, et al. Point-of-care ultrasound for risk stratification of urgent urological care in acute uncomplicated renal colic. CJEM. 2025;27:984-94.

9. Popat A, Harikrishnan S, Seby N, Sen U, Patel SK, Mittal L, et al. Utilization of point-of-care ultrasound as an imaging modality in the emergency department: A systematic review and meta-analysis. Cureus. 2024;16(1):e52371.
10. Pathan SA, Mitra B, Mirza S, Momin U, Ahmed Z, Andraous LG, et al. Emergency physician interpretation of point-of-care ultrasound for identifying and grading of hydronephrosis in renal colic compared with consensus interpretation by emergency radiologists. Acad Emerg Med. 2018;25(10):1129-37.
11. Sibley S, Roth N, Scott C, Rang L, White H, Sivilotti MLA, et al. Point-of-care ultrasound for the detection of hydronephrosis in emergency department patients with suspected renal colic. Ultrasound J. 2020;12(1):31.
12. Al-Balushi A, Al-Shibli A, Al-Reesi A, Ullah QZ, Al-Shukaili W, Baawain S, et al. The accuracy of point-of-care ultrasound performed by emergency physicians in detecting hydronephrosis in patients with renal colic. Sultan Qaboos Univ Med J. 2022;22(3):351-6.
13. Yıldırım A, Ardic S, Cicek M, Kadıoğlu ME, Cekic OG, Akyuz S, et al. Agreement between emergency medicine residents and a radiologist in ultrasonographic detection and grading of hydronephrosis in patients with suspected renal colic: a prospective study. Emerg Radiol.2026;1-11.
14. Sasipattarapong P, Omer T, Sajed D, Shin H, Lam CN, Mailhot T. Point-of-care renal ultrasound: Are longitudinal views of the kidney alone sufficient to rule out hydronephrosis? JACEP Open. 2022;3(4);e12794.