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A Cost-effective Way to Evaluate Patients with Recurrent Renal Colic

By Michelle Lin, MD, MPH and Jeremiah D. Schuur, MD, MHS | on January 8, 2014 | 0 Comment
Opinion
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A Better Approach to Managing Recurrent Renal Colic

Urinalysis and bedside renal ultrasound are effective, safe, and less expensive than repeat CT scans

Introducing the Cost-Effective Care Series

Every day, there is increasing pressure from patients, payers, and government to get more value for health care spending. Too often, health care stories cite problems with our current system but don’t offer solutions. As practicing physicians, we are committed to first do no harm—and that includes financial harm—but we receive little guidance on specific ways to help fix the many problems in our health care system. In the emergency department, we influence health care costs through the tests, treatments, and hospital admissions we order every day. This series will address common emergency department presentations and identify a diagnostic or treatment strategy that is efficient, safe, evidence-based, and more cost effective than how we frequently deliver care. Some of you may be practicing this way already; others may think we’re crazy. Continue the conversation and send us your feedback on social media at @ACEPNow.

“Doctor, EMS just brought a man who is really uncomfortable into bay 4. He looks like he has a kidney stone, and he’s had one before. Can I give him some morphine?”

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Explore This Issue
ACEP Now: Vol 33 – No 01 – January 2014

“Sure, put him in for a CT, and I’ll see him in a few minutes.”

Every day, emergency departments across the United States care for similar patients. Kidney stones affect one in 11 adults in the United States, and their prevalence has increased 40 percent in the past decade. Renal colic accounts for more than 700,000 emergency-department visits annually, and in 2009, 71 percent of these patients underwent CT examination. Depending on how it’s measured, the use of CT for renal colic has increased between three- and tenfold in the last two decades.1,2

Among patients presenting with recurrent acute renal colic, should non-contrast CT of the abdomen be the standard diagnostic approach?

CT of the abdomen is the preferred diagnostic test to identify kidney stones due to its accuracy, speed, and widespread availability. Sensitivity ranges from 94 percent to 100 percent, while specificity ranges from 92 percent to 100 percent. CT is the test of choice for patients presenting with first-time renal colic or potentially complicated renal colic (eg, fever, a single kidney, or immunosuppression). Additionally, in patients in whom you suspect a serious alternate cause of their flank pain (eg, dissecting abdominal aortic aneurysm), CT should be performed. However, while CT is useful to detect extra-renal pathology, the rapid increase in CT use has not resulted in an increased incidence of alternate pathologies.

Pages: 1 2 3 | Single Page

Topics: Cost of Health CareCost-Effective CareCritical CareEmergency MedicineEmergency PhysicianImaging and UltrasoundInternal MedicinePainPractice ManagementPractice TrendsProcedures and SkillsRenalUltrasound

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About the Authors

Michelle Lin, MD, MPH

Michelle Lin, MD, MPH, is an attending emergency physician and a fellow in the Division of Health Policy Research and Translation in the Department of Emergency Medicine, Brigham and Women’s Hospital in Boston. She also serves as an instructor at Harvard Medical School.

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Jeremiah D. Schuur, MD, MHS

Jeremiah D. Schuur, MD, MHS, is vice chair of quality and safety and chief of the Division of Health Policy Research and Translation in the Department of Emergency Medicine, Brigham & Women’s Hospital in Boston. He also serves as assistant professor at Harvard Medical School.

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