Boyd R, Gray A J
Department of Accident and Emergency, Royal Infirmary of Edinburgh, United Kingdom.
J Accid Emerg Med. 1996 Nov;13(6):390-1. doi: 10.1136/emj.13.6.390.
(1) To determine the accuracy of accident and emergency (A&E) doctors' diagnosis of radio-opaque ureteric calculi on plain abdominal radiographs; (2) to study the predictive value of haematuria with a history suggestive of ureteric colic.
A prospective study of all patients seen in a three month period with a provisional diagnosis of ureteric colic. Intravenous urography (IVU) was used as the gold standard for diagnosis of ureteric calculi.
The accident and emergency department and medical unit of a large teaching hospital.
60 patients who were admitted with an initial diagnosis of ureteric colic, 51 subsequently undergoing intravenous urography.
A&E doctors achieved a calculated sensitivity of 29% (95% confidence intervals 13% to 49%) and a specificity of 73% (52% to 90%) for identification of renal calculi on plain abdominal radiograph, compared with figures of 68% (48% to 84%) and 96% (78% to 100%) respectively for consultant radiologists. The difference between these results was highly significant (P = 0.0011). No patient with a definitive diagnosis of ureteric colic had a negative result for haematuria on urinary dipstick analysis.
A&E doctors are poor at identifying radio-opaque ureteric calculi on plain abdominal radiographs. If haematuria is absent on urinalysis then ureteric colic is an unlikely diagnosis.
（1）确定急诊医生通过腹部平片诊断不透X线的输尿管结石的准确性；（2）研究有输尿管绞痛病史的血尿的预测价值。
对在三个月期间初步诊断为输尿管绞痛的所有患者进行前瞻性研究。静脉肾盂造影（IVU）被用作诊断输尿管结石的金标准。
一家大型教学医院的急诊科和内科病房。
60例最初诊断为输尿管绞痛入院的患者，其中51例随后接受了静脉肾盂造影。
与放射科会诊医生分别为68%（48%至84%）和96%（78%至100%）的数据相比，急诊医生通过腹部平片识别肾结石的计算灵敏度为29%（95%置信区间为13%至49%），特异性为73%（52%至90%）。这些结果之间的差异具有高度统计学意义（P = 0.0011）。所有确诊为输尿管绞痛的患者尿试纸分析血尿结果均为阳性。
急诊医生通过腹部平片识别不透X线的输尿管结石的能力较差。如果尿液分析中没有血尿，则不太可能诊断为输尿管绞痛。
