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Author Spotlight: Developing a Bedside Protocol for Kidney and Genitourinary Ultrasonography
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Ultrasonography versus computed tomography for suspected nephrolithiasis.

Rebecca Smith-Bindman1, Chandra Aubin, John Bailitz

  • 1From the Departments of Radiology and Biomedical Imaging (R.S.-B., R.B.G., M. Moghadassi), Epidemiology and Biostatistics and the Philip R. Lee Institute for Health Policy Studies (R.S.-B.), Urology (M.L.S.), Medicine (V.E.V.), and Emergency Medicine (R.C.W.), University of California, San Francisco (UCSF), and the San Francisco Coordinating Center, California Pacific Medical Center Research Institute (D.R.K., S.R.C.), San Francisco, the Department of Emergency Medicine, UCSF, Fresno (R.N.B.), Keck School of Medicine of the University of Southern California, Los Angeles (T.L.K.), Center for Healthcare Policy and Research (J.M.) and Division of Biostatistics, Department of Public Health Sciences (D.L.M.) and the Department of Emergency Medicine (L.D.M.), University of California, Davis - all in California; the Division of Emergency Medicine, Washington University School of Medicine, St. Louis (C.A., R.T.G.); Department of Emergency Medicine, John H. Stroger, Jr. Hospital of Cook County, and the Department of Emergency Medicine, Rush University Medical Center - both in Chicago (J.B.); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (C.A.C., V.E.N.); Department of Emergency Medicine, Jacobi Medical Center, Bronx, NY (J.C., J.W.); Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia (A.J.D.); Rhode Island Hospital and Brown University Department of Emergency Medicine, Providence (G.D.J.); Department of Emergency Medicine, Oregon Health and Science University, Portland (O.J.M.); and Group Health Research Institute, Group Health Cooperative, Seattle (D.L.M.); University of Utah, Salt Lake City (M. Mallin); Emory University School of Medicine, Atlanta (W.M.); University of Texas Health Science Center at Houston (S.K.M.) and the University of Texas at Houston Medical School (G.M.P.) - both in Houston; and the Hennepin County Medical Center, Minneapolis (J.R.M.).

The New England Journal of Medicine
|September 18, 2014
PubMed
Summary
This summary is machine-generated.

Initial ultrasonography for suspected kidney stones offers lower radiation exposure than computed tomography (CT) scans. This imaging method showed no significant differences in high-risk diagnoses, adverse events, or patient outcomes.

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Area of Science:

  • Nephrology
  • Radiology
  • Emergency Medicine

Background:

  • Lack of consensus exists regarding the optimal initial imaging modality for suspected nephrolithiasis.
  • Computed tomography (CT) and ultrasonography are primary diagnostic options.

Purpose of the Study:

  • To compare the effectiveness of point-of-care ultrasonography, radiology ultrasonography, and CT for initial diagnosis of suspected nephrolithiasis.
  • To evaluate patient outcomes and radiation exposure associated with each imaging method.

Main Methods:

  • Multicenter, pragmatic, comparative effectiveness trial involving 2759 patients aged 18-76.
  • Random assignment to point-of-care ultrasonography, radiology ultrasonography, or abdominal CT.
  • Comparison of 30-day high-risk diagnoses with complications and 6-month cumulative radiation exposure.

Main Results:

  • Low incidence of high-risk diagnoses with complications (0.4%) across all groups.
  • Significantly lower cumulative radiation exposure in ultrasonography groups compared to CT (P<0.001).
  • No significant differences in serious adverse events, pain scores, return emergency department visits, hospitalizations, or diagnostic accuracy.

Conclusions:

  • Initial ultrasonography is associated with reduced cumulative radiation exposure compared to initial CT.
  • Ultrasonography is a safe and effective alternative, demonstrating comparable outcomes regarding complications, adverse events, and patient experience.