Advocating for Change: Unveiling the Challenges of an Ultrasound-First Approach in Uncomplicated Renal Colic

In recent years, medical literature has advocated for an ultrasound-first (US-first) approach for the diagnosis of uncomplicated renal colic. Despite these recommendations, computed tomography (CT) continues to be overutilized.

This project had a three-pronged approach: 1) to investigate the current diagnostic choice and factors that influence it for uncomplicated renal colic within our local healthcare system, 2) to create and implement an algorithm to emphasize the use of a US-first approach for uncomplicated patients, and 3) to identify the effectiveness of the clinical algorithm.

An initial five-month retrospective evaluation (2020-2021), including regional and tertiary emergency departments (EDs), was performed to review emergency provider practice patterns when investigating renal colic. In conjunction with this, a clinician survey was performed to identify factors affecting providers' choice of diagnostic imaging for renal colic. Next, a multidisciplinary group of providers developed a clinical algorithm advocating for a US-first approach to diagnosing uncomplicated renal colic. Finally, a postintervention retrospective evaluation was conducted in 2023 to evaluate the effectiveness of this clinical algorithm.

The initial retrospective study showed CT as the primary diagnostic choice (used in 102 out of 135 patients) for investigating uncomplicated renal colic. After the implementation of the clinical algorithm, there was a significant reduction in CT scans by 14.2% (p = 0.016). There were no significant differences in the need for urological interventions, hospitalization, repeat ED visits within one week, or missed serious diagnoses.

This study demonstrated the effectiveness of a multidisciplinary-derived clinical algorithm in successfully reducing the use of CT scans in uncomplicated renal colic. The US-first approach was utilized in a higher percentage of patients following the introduction of the clinical algorithm; however, CT still dominated as the primary diagnostic choice.