Role of the plain radiograph and urinalysis in acute ureteric colic.
OBJECTIVE
(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.


METHODS
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.


METHODS
The accident and emergency department and medical unit of a large teaching hospital.


METHODS
60 patients who were admitted with an initial diagnosis of ureteric colic, 51 subsequently undergoing intravenous urography.


RESULTS
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.


CONCLUSIONS
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.
Boyd
R
R
Department of Accident and Emergency, Royal Infirmary of Edinburgh, United Kingdom.
Gray
A J
AJ
D003085:Colic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D006417:Hematuria / Q000175:diagnosis; D006801:Humans; D011446:Prospective Studies; D014514:Ureteral Calculi / Q000150:complications / Q000000981:diagnostic imaging; D014515:Ureteral Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D016482:Urinalysis; D014567:Urography