Ralph C Wang1, Robert M Rodriguez2, Jahan Fahimi2, M Kennedy Hall3, Stephen Shiboski4, Tom Chi5, Rebecca Smith-Bindman6. 1. Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA. Electronic address: ralph.wang@ucsf.edu. 2. Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA. 3. Division of Emergency Medicine, University of Washington, Seattle, WA, USA. 4. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA. 5. Department of Urology, University of California, San Francisco, San Francisco, CA, USA. 6. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
Abstract
OBJECTIVE: Routine CT for patients with acute flank pain has not been shown to improve patient outcomes, and it may unnecessarily expose patients to radiation and increased costs. As preliminary steps toward the development of a guideline for selective CT, we sought to determine the prevalence of clinically important outcomes in patients with acute flank pain and derive preliminary decision rules. METHODS: We analyzed data from a randomized trial of CT vs. ultrasonography for patients with acute flank pain from 15 EDs between October 2011 and February 2013. Clinically important outcomes were defined as inpatient admission for ureteral stones and alternative diagnoses. Clinically important stones were defined as stones requiring urologic intervention. We sought to derive highly sensitive decision rules for both outcomes. RESULTS: Of 2759 participants, 236 (8.6%) had a clinically important outcome and 143 (5.2%) had a clinically important stone. A CDR including anemia (hemoglobin <13.2g/dl), WBC count >11000/μl, age>42years, and the absence of CVAT had a sensitivity of 97.9% (95% CI 94.8-99.2%) and specificity of 18.7% (95% 17.2-20.2%) for clinically important outcome. A CDR including hydronephrosis, prior history of stone, and WBC count <8300/μl had a sensitivity of 98.6% (95% CI 94.5-99.7%) and specificity of 26.0% (95% 24.2-27.7%) for clinically important stone. CONCLUSIONS: We determined the prevalence of clinically important outcomes in patients with acute flank pain, and derived preliminary high sensitivity CDRs that predict them. Validation of CDRs with similar test characteristics would require prospective enrollment of 2100 patients.
OBJECTIVE: Routine CT for patients with acute flank pain has not been shown to improve patient outcomes, and it may unnecessarily expose patients to radiation and increased costs. As preliminary steps toward the development of a guideline for selective CT, we sought to determine the prevalence of clinically important outcomes in patients with acute flank pain and derive preliminary decision rules. METHODS: We analyzed data from a randomized trial of CT vs. ultrasonography for patients with acute flank pain from 15 EDs between October 2011 and February 2013. Clinically important outcomes were defined as inpatient admission for ureteral stones and alternative diagnoses. Clinically important stones were defined as stones requiring urologic intervention. We sought to derive highly sensitive decision rules for both outcomes. RESULTS: Of 2759 participants, 236 (8.6%) had a clinically important outcome and 143 (5.2%) had a clinically important stone. A CDR including anemia (hemoglobin <13.2g/dl), WBC count >11000/μl, age>42years, and the absence of CVAT had a sensitivity of 97.9% (95% CI 94.8-99.2%) and specificity of 18.7% (95% 17.2-20.2%) for clinically important outcome. A CDR including hydronephrosis, prior history of stone, and WBC count <8300/μl had a sensitivity of 98.6% (95% CI 94.5-99.7%) and specificity of 26.0% (95% 24.2-27.7%) for clinically important stone. CONCLUSIONS: We determined the prevalence of clinically important outcomes in patients with acute flank pain, and derived preliminary high sensitivity CDRs that predict them. Validation of CDRs with similar test characteristics would require prospective enrollment of 2100 patients.
Authors: Meghan K Herbst; Graeme Rosenberg; Brock Daniels; Cary P Gross; Dinesh Singh; Annette M Molinaro; Seth Luty; Christopher L Moore Journal: Ann Emerg Med Date: 2014-03-11 Impact factor: 5.721
Authors: Rebecca Smith-Bindman; Chandra Aubin; John Bailitz; Rimon N Bengiamin; Carlos A Camargo; Jill Corbo; Anthony J Dean; Ruth B Goldstein; Richard T Griffey; Gregory D Jay; Tarina L Kang; Dana R Kriesel; O John Ma; Michael Mallin; William Manson; Joy Melnikow; Diana L Miglioretti; Sara K Miller; Lisa D Mills; James R Miner; Michelle Moghadassi; Vicki E Noble; Gregory M Press; Marshall L Stoller; Victoria E Valencia; Jessica Wang; Ralph C Wang; Steven R Cummings Journal: N Engl J Med Date: 2014-09-18 Impact factor: 91.245
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Authors: Ralph C Wang; Robert M Rodriguez; Michelle Moghadassi; Vicki Noble; John Bailitz; Mike Mallin; Jill Corbo; Tarina L Kang; Phillip Chu; Steve Shiboski; Rebecca Smith-Bindman Journal: Ann Emerg Med Date: 2015-10-03 Impact factor: 5.721
Authors: M Kennedy Hall; Patrick C Samson; Ross Kessler; Kris Lehnhardt; Benjamin Easter; Jeff Thiel; Hunter Wessells; Michael R Bailey; Jonathan D Harper Journal: J Am Coll Emerg Physicians Open Date: 2020-03-25
Authors: Abdullatif Al-Terki; Ahmed R El-Nahas; Usama Abdelhamid; Mohamed A Al-Ruwaished; Talal Alanzi; Tariq F Al-Shaiji Journal: Arab J Urol Date: 2020-05-19