title: Emergency Department Imaging Modality Effect on Surgical Management of Nephrolithiasis: A Multicenter, Randomized Clinical Trial.
abstract: In the emergency department ultrasonography is emerging as an alternative to computerized tomography for diagnosing patients with nephrolithiasis. In this multicenter randomized clinical trial we examined rates of urological referral and intervention to elucidate whether the initial diagnostic imaging modality affected the management of nephrolithiasis.
  
  
  
  Patients 18 to 76 years old who presented to the emergency department with renal colic across 15 diverse treatment centers were randomized to receive abdominal ultrasonography by an emergency department physician or a radiologist, or abdominal computerized tomography. We analyzed the 90-day followup for patients diagnosed with nephrolithiasis to assess subsequent urological evaluation, procedure type and time to intervention.
  
  
  
  Of 1,666 patients diagnosed with nephrolithiasis in the emergency department 241 (14.5%) had a consultation with urology at initial presentation, 503 (30%) saw a urologist in followup and 192 (12%) underwent at least 1 urological procedure. Median time to outpatient procedure and type of procedure performed did not vary significantly among imaging groups. Most patients (78%) had computerized tomography performed before elective intervention. Patients with ultrasonography performed by an emergency department physician were 2.6 times more likely to undergo computerized tomography before intervention than those who had ultrasonography performed by a radiologist.
  
  
  
  Patients undergoing a urological intervention who had ultrasonography as initial imaging do not experience a significant delay to intervention or different procedure types, but the majority ultimately undergoes computerized tomography before surgery. Formal ultrasonography by a radiologist may encourage less computerized tomography preoperatively.
authors: Department of Urology, University of California San Francisco, San Francisco, California. Electronic address: ian.metzler@ucsf.edu.
authors: Ian S
authors: IS
authors: Metzler
authors: Department of Radiology, University of California San Francisco, San Francisco, California.
authors: Rebecca
authors: R
authors: Smith-Bindman
authors: Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, California.
authors: Michelle
authors: M
authors: Moghadassi
authors: Department of Emergency Medicine, University of California San Francisco, San Francisco, California.
authors: Ralph C
authors: RC
authors: Wang
authors: Department of Urology, University of California San Francisco, San Francisco, California.
authors: Marshall L
authors: ML
authors: Stoller
authors: Department of Urology, University of California San Francisco, San Francisco, California.
authors: Thomas
authors: T
authors: Chi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D061665:Time-to-Treatment; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D055815:Young Adult
keywords: emergency service; hospital; nephrolithiasis; tomography; treatment outcome; ultrasonography; x-ray computed