Shrestha R, Shakya R M, Khan A A
Department of Emergency Medicine, Manmohan Memorial Teaching Hospital, Swoyambhu, Nepal.
Kathmandu Univ Med J (KUMJ). 2016 Apr-Jun;14(54):172-176.
Background Renal colic is a common emergency department presentation. Hydronephrosis is indirect sign of urinary obstruction which may be due to obstructing ureteric calculus and can be detected easily by bedside ultrasound with minimal training. Objective To compare the accuracy of detection of hydronephrosis performed by the emergency physician with that of radiologist's in suspected renal colic cases. Method This was a prospective observational study performed over a period of 6 months. Patients >8 years with provisional diagnosis of renal colic with both the bedside ultrasound and the formal ultrasound performed were included. Presence of hydronephrosis in both ultrasounds and size and location of ureteric stone if present in formal ultrasound was recorded. The accuracy of the emergency physician detection of hydronephrosis was determined using the scan reported by the radiologists as the "gold standard" as computed tomography was unavailable. Statistical analysis was executed using SPSS 17.0. Result Among the 111 included patients, 56.7% had ureteric stone detected in formal ultrasound. The overall sensitivity, specificity, positive predictive value and negative predictive value of bedside ultrasound performed by emergency physician for detection of hydronephrosis with that of formal ultrasound performed by radiologist was 90.8%., 78.3%, 85.5% and 85.7% respectively. Bedside ultrasound and formal ultrasound both detected hydronephrosis more often in patients with larger stones and the difference was statistically significant (p=.000). Conclusion Bedside ultrasound can be potentially used as an important tool in detecting clinically significant hydronephrosis in emergency to evaluate suspected ureteric colic. Focused training in ultrasound could greatly improve the emergency management of these patients.
背景 肾绞痛是急诊科常见的病症表现。肾积水是尿路梗阻的间接征象，可能由输尿管结石梗阻引起，并且经过最少的培训后，床边超声就能轻松检测到。目的 比较急诊医生与放射科医生在疑似肾绞痛病例中检测肾积水的准确性。方法 这是一项为期6个月的前瞻性观察性研究。纳入年龄大于8岁、初步诊断为肾绞痛且同时进行了床边超声和正式超声检查的患者。记录两次超声检查中肾积水的情况，以及正式超声检查中输尿管结石（若存在）的大小和位置。由于无法进行计算机断层扫描，因此将放射科医生报告的扫描结果作为“金标准”，以确定急诊医生检测肾积水的准确性，并使用SPSS 17.0进行统计分析。结果 在111例纳入患者中，正式超声检查发现56.7%的患者有输尿管结石。急诊医生进行的床边超声检测肾积水与放射科医生进行的正式超声检测肾积水相比，总体敏感性、特异性、阳性预测值和阴性预测值分别为90.8%、78.3%、85.5%和85.7%。床边超声和正式超声在结石较大的患者中更常检测到肾积水，差异具有统计学意义（p = 0.000）。结论 床边超声可作为急诊科检测临床上有意义的肾积水以评估疑似输尿管绞痛的重要工具。针对超声的集中培训可大大改善这些患者的急诊处理。
