Department of Emergency Medicine, University of Florida, Gainesville, FL 32608, USA.
CJEM. 2005 Mar;7(2):78-86. doi: 10.1017/s1481803500013026.
There is no set of prospectively validated criteria to identify the emergency department (ED) patients with renal colic who are most likely to eventually have to undergo an intervention. This study prospectively assessed predictors of intervention in this patient population.
This prospective cohort study included adult patients with renal colic who presented to 2 tertiary care hospital EDs. Patients had an 18-variable data form completed by an emergency physician and a radiological study to confirm urolithiasis. After discharge, patients were followed at 1 and 4 weeks to assess for intervention. The outcome criteria included the patient having had at least 1 of the following procedures performed: extracorporeal shockwave lithotripsy (ESWL), ureteroscopy, percutaneous nephrostomy or open surgery. Data were analyzed using appropriate univariate techniques, and those variables associated with intervention were combined using logistic regression analysis.
Over an 8-month period, 245 patients with confirmed urolithiasis were followed; 20% (95% confidence interval [CI] 15%-25%) eventually had a procedure to remove their calculi. Three variables were significantly correlated with having a procedure: i) size of calculus >or= 6 mm (odds ratio [OR] 10.7, 95% CI 4.6-24.8), ii) location of calculus above mid-ureter (OR 6.9, 95% CI 3.0-15.9), and iii) Visual Analogue Scale score for pain at discharge from the ED >or= 2 cm (OR 2.6, 95% CI 1.0-6.8). The area under receiver operating characteristic curve was 0.77 (95% C I 0.70-0.84) (p < 0.001). If all variables were present there was a 90% probability of the patient having an intervention performed within 4 weeks of discharge from the ED. Conversely, if none of the variables were present there was only a 4% probability of an intervention. Overall, the model had a sensitivity of 92% (95% CI 89%-96%) and a specificity of 63% (95% CI 57%-69%).
This study has identified variables that could potentially be used to identify those renal colic patients who require an intervention after ED evaluation. Future studies will prospectively validate this model.
目前尚无一套经前瞻性验证的标准来识别急诊科（ED）中那些最有可能需要接受干预的肾绞痛患者。本研究前瞻性评估了该患者人群中干预的预测因素。
这项前瞻性队列研究纳入了就诊于 2 家三级保健医院 ED 的成年肾绞痛患者。由急诊医生为患者填写一份包含 18 个变量的数据表单，并进行影像学检查以确认尿路结石。出院后，在 1 周和 4 周时对患者进行随访，以评估是否需要干预。主要结局标准包括患者至少接受了以下 1 种治疗程序：体外冲击波碎石术（ESWL）、输尿管镜检查、经皮肾造口术或开放性手术。使用适当的单变量技术对数据进行分析，并使用逻辑回归分析对与干预相关的变量进行组合。
在 8 个月的时间里，共对 245 例经证实患有尿路结石的患者进行了随访；20%（95%置信区间[CI] 15%-25%）的患者最终接受了取石手术。有 3 个变量与接受治疗程序显著相关：i）结石大小≥6mm（比值比[OR] 10.7，95%CI 4.6-24.8），ii）结石位于输尿管中段以上（OR 6.9，95%CI 3.0-15.9），iii）ED 出院时视觉模拟评分（VAS）疼痛评分≥2cm（OR 2.6，95%CI 1.0-6.8）。受试者工作特征曲线下面积为 0.77（95%CI 0.70-0.84）（p<0.001）。如果所有变量都存在，则患者在 ED 出院后 4 周内进行干预的可能性为 90%。相反，如果没有任何变量，则进行干预的可能性仅为 4%。总体而言，该模型的敏感性为 92%（95%CI 89%-96%），特异性为 63%（95%CI 57%-69%）。
本研究确定了一些变量，这些变量可能有助于识别 ED 评估后需要干预的肾绞痛患者。未来的研究将前瞻性验证该模型。
