Pham Cecile T, Hui Nicholas, Yan Regine, Richardson Emma, Phanse Salonee, Cohen Jordan E, McClintock George, Parameswaran Ahilan, Smith Matthew, Mitterdorfer Andrew, Boulas John, Gassner Paul, Patel Dinesh, Sved Paul
Department of Urology, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia.
North Shore Urology Research Group, St. Leonards, New South Wales, Australia.
Can Urol Assoc J. 2023 Jul;17(7):E176-E181. doi: 10.5489/cuaj.8136.
Renal colic is a common emergency department (ED) presentation. Variations in assessment and management of suspected renal colic may have significant implications on patient and hospital outcomes. We developed a clinical practice guideline to standardize the assessment and management of renal colic in the ED. We subsequently compared outcomes before and after guideline implementation.
The guideline standardizes the analgesia regimen, urology consult criteria, imaging modality, patient education, and followup instructions. This is a single-center, observational cohort study of patients presenting to the ED with renal colic prospectively collected after guideline implementation (December 2018 to May 2019) compared to a control group retrospectively collected before guideline implementation (December 2017 to May 2018). A total of 528 patients (pre-guideline n=283, post-guideline n=245) were included. Statistical analysis was performed with SPSS using multivariate linear regression.
ED length of stay (LOS) was significantly shorter after guideline implementation (pre-guideline 295.82±178.8 minutes vs. post-guideline 253.2±118.2 minutes, p=0.017). The number of computed tomography (CT) scans patients received was significantly less after guideline implementation (pre guideline 1.35±1.34 vs. post-guideline 1.00±0.68, p=0.034). Patients discharged for conservative management had a lower re-presentation rate in the post-guideline group (12.6%) than the pre-guideline group (17.2%); however, this did not reach statistical significance (p=0.18).
Implementation of a clinical practice guideline for ureteric stones reduces the ED LOS and the total number of CT scan in patients who present with renal colic. Standardizing assessment and management of ureteric stones can potentially improve patient and hospital outcomes without compromising the quality of care.
肾绞痛是急诊科常见的病症。疑似肾绞痛评估和管理的差异可能对患者和医院的治疗结果产生重大影响。我们制定了一项临床实践指南，以规范急诊科肾绞痛的评估和管理。随后，我们比较了指南实施前后的治疗结果。
该指南规范了镇痛方案、泌尿外科会诊标准、成像方式、患者教育和随访指导。这是一项单中心观察性队列研究，将指南实施后（2018年12月至2019年5月）前瞻性收集的急诊科肾绞痛患者与指南实施前（2017年12月至2018年5月）回顾性收集的对照组进行比较。共纳入528例患者（指南实施前n = 283，指南实施后n = 245）。使用SPSS进行多变量线性回归统计分析。
指南实施后急诊科住院时间（LOS）显著缩短（指南实施前295.82±178.8分钟，指南实施后253.2±118.2分钟，p = 0.017）。指南实施后患者接受计算机断层扫描（CT）的次数显著减少（指南实施前1.35±1.34，指南实施后1.00±0.68，p = 0.034）。出院接受保守治疗的患者在指南实施后组的再就诊率（12.6%）低于指南实施前组（17.2%）；然而，这未达到统计学意义（p = 0.18）。
输尿管结石临床实践指南的实施减少了肾绞痛患者的急诊科住院时间和CT扫描总数。规范输尿管结石的评估和管理可能在不影响护理质量的情况下改善患者和医院的治疗结果。
