title: Young patients with suspected uncomplicated renal colic are unlikely to have dangerous alternative diagnoses or need emergent intervention.
abstract: BACKGROUND
  In the United States there is debate regarding the appropriate first test for new-onset renal colic, with non-contrast helical computed tomography (CT) receiving the highest ratings from both Agency for Healthcare Research and Quality and the American Urological Association. This is based not only on its accuracy for the diagnosis of renal colic, but also its ability to diagnose other surgical emergencies, which have been thought to occur in 10-15% of patients with suspected renal colic, based on previous studies. In younger patients, it may be reasonable to attempt to avoid immediate CT if concern for dangerous alternative diagnosis is low, based on the risks of radiation from CTs, and particularly in light of evidence that patients with renal colic have a very high likelihood of having multiple CTs in their lifetimes. The objective is to determine the proportion of patients with a dangerous alternative diagnosis in adult patients age 50 and under presenting with uncomplicated (non-infected) suspected renal colic, and also to determine what proportion of these patients undergo emergent urologic intervention.
  
  
  METHODS
  Retrospective chart review of 12 months of patients age 18-50 presenting with "flank pain," excluding patients with end stage renal disease, urinary tract infection, pregnancy and trauma. Dangerous alternative diagnosis was determined by CT.
  
  
  RESULTS
  Two hundred and ninety-one patients met inclusion criteria. One hundred and fifteen patients had renal protocol CTs, and zero alternative emergent or urgent diagnoses were identified (one-sided 95% CI [0-2.7%]). Of the 291 encounters, there were 7 urologic procedures performed upon first admission (2.4%, 95% CI [1.0-4.9%]). The prevalence of kidney stone by final diagnosis was 58.8%.
  
  
  CONCLUSIONS
  This small sample suggests that in younger patients with uncomplicated renal colic, the benefit of immediate CT for suspected renal colic should be questioned. Further studies are needed to determine which patients benefit from immediate CT for suspected renal colic, and which patients could undergo alternate imaging such as ultrasound.
authors.affiliation: Baystate Medical Center/Tufts School of Medicine, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Schoenfeld
authors.affiliation: Baystate Medical Center/Tufts School of Medicine, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Kye E
authors.initials: KE
authors.lastname: Poronsky
authors.affiliation: Baystate Medical Center/Tufts School of Medicine, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Tala R
authors.initials: TR
authors.lastname: Elia
authors.affiliation: Baystate Medical Center/Tufts School of Medicine, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Gavin R
authors.initials: GR
authors.lastname: Budhram
authors.affiliation: Baystate Medical Center/Tufts School of Medicine, Epidemiology/Biostatistics, Department of Academic Affairs, Boston, Massachusetts.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Garb
authors.affiliation: Baystate Medical Center/Tufts School of Medicine, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Mader
mesh_terms: D000293:Adolescent; D000328:Adult; D003955:Diagnostic Tests, Routine; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D056844:Renal Colic / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
references.citation: Ann Emerg Med. 2014 Sep;64(3):292-8
references.pmid: 24746846
references.citation: BMJ. 1995 Sep 2;311(7005):619-20
references.pmid: 7663258
references.citation: N Engl J Med. 2014 Sep 18;371(12):1100-10
references.pmid: 25229916
references.citation: Urology. 2000 Jul;56(1):53-7
references.pmid: 10869622
references.citation: Ann Emerg Med. 2005 Apr;45(4):448-51
references.pmid: 15795729
references.citation: AJR Am J Roentgenol. 2002 Jan;178(1):101-3
references.pmid: 11756098
references.citation: Acad Emerg Med. 2013 May;20(5):470-8
references.pmid: 23672361
references.citation: BMC Urol. 2003 Mar 17;3:2
references.pmid: 12675951
references.citation: Kidney Int. 2013 Mar;83(3):479-86
references.pmid: 23283137
references.citation: J Emerg Med. 2004 Oct;27(3):225-31
references.pmid: 15388206
references.citation: Acad Emerg Med. 2011 Jul;18(7):699-707
references.pmid: 21762233
references.citation: Am J Emerg Med. 2014 Apr;32(4):367-70
references.pmid: 24440589
references.citation: BMJ. 2013;346:f2360
references.pmid: 23694687
references.citation: J Emerg Med. 2007 Aug;33(2):161-8
references.pmid: 17692768
references.citation: Arch Intern Med. 2009 Dec 14;169(22):2071-7
references.pmid: 20008689
references.citation: Lancet. 2012 Aug 4;380(9840):499-505
references.pmid: 22681860
references.citation: Acad Emerg Med. 2014 Feb;21(2):211-3
references.pmid: 24438041
references.citation: J Educ Eval Health Prof. 2013 Nov 30;10:12
references.pmid: 24324853
references.citation: BMJ. 2014;348:g2191
references.pmid: 24671981
references.citation: Eur Urol. 2007 Dec;52(6):1610-31
references.pmid: 18074433
references.citation: J Urol. 2006 May;175(5):1725-30; discussion 1730
references.pmid: 16600742