title: Impact in the emergency department of unenhanced CT on diagnostic confidence and therapeutic efficacy in patients with suspected renal colic: a prospective survey. 2000 ARRS President's Award. American Roentgen Ray Society.
abstract: OBJECTIVE
  Our objective was to evaluate the impact of unenhanced CT on clinician diagnostic confidence and therapeutic efficacy in emergency department patients with clinically suspected renal colic.
  
  
  METHODS
  Questionnaires were completed on 93 patients who were referred to the radiology department with clinically suspected renal colic. We prospectively surveyed the clinician's diagnostic confidence and treatment plan before and after unenhanced abdominal and pelvic CT.
  
  
  RESULTS
  Fifty-six patients (60%) had positive findings for calculi, 20 patients (22%) had normal findings, and alternative diagnoses were found in 17 patients (18%). The clinician's diagnostic certainty of stones before CT was variable with the largest frequencies at 41-60% (n = 30) and 71-90% (n = 35). The diagnostic certainty of stones after CT showed movement toward either less than or equal to 10% (n = 25) or greater than or equal to 91% (n = 51). The mean change in diagnostic confidence was 34%. Fifty-seven patients (61%) had a change in treatment plan. Specifically, the need for urology consultation as the initial treatment plan was reduced from 24 patients to one patient. Plans for admissions suggested before CT (n = 11) were nearly cut in half (n = 6) after imaging. Lastly, seven patients who would have initially been discharged were admitted to the hospital after imaging.
  
  
  CONCLUSIONS
  CT significantly increased emergency department clinician diagnostic confidence and altered initial treatment decisions in patients with suspected renal colic. Most often, CT confirmed a ureteral stone and allowed appropriate discharge or urologic intervention. In a smaller subset of patients, CT established a significant alternative diagnosis that allowed the prompt initiation of appropriate treatment.
authors.affiliation: Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106, USA.
authors.forename: S
authors.initials: S
authors.lastname: Abramson
authors.forename: N
authors.initials: N
authors.lastname: Walders
authors.forename: K E
authors.initials: KE
authors.lastname: Applegate
authors.forename: R C
authors.initials: RC
authors.lastname: Gilkeson
authors.forename: M R
authors.initials: MR
authors.lastname: Robbin
mesh_terms: D000328:Adult; D003085:Colic / Q000000981:diagnostic imaging* / Q000628:therapy; D003625:Data Collection; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000000981:diagnostic imaging* / Q000628:therapy; D008297:Male; D010343:Patient Admission; D010347:Patient Care Planning; D011446:Prospective Studies; D012017:Referral and Consultation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000000981:diagnostic imaging