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Predicting surgery within one week of emergency department presentation for renal colic using the CLAD-MB score: A
Frederic Balen1, Cédrick Cideron2, Marc Noizet3
1Emergency Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Centre d'Epidémiologie et de Recherche en santé des POPulations de Toulouse - EQUITY team, INSERM, Toulouse, France; Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.
Background:
The Complicated UroLithiasis and Alternative Diagnoses (CLAD) score was derived from a retrospective cohort to predict the likelihood of surgery within 7 days following emergency department (ED) presentation for renal colic. The objective of this study was to prospectively refine and validate the CLAD score.
Methods:
This was a prospective observational study conducted in five French EDs between July 6, 2021, and July 6, 2023. Patients aged 18 years and older who presented to the ED with renal colic were included. The primary outcome was surgical intervention within 7 days of the ED visit. Logistic regression was used to identify risk factors associated with the need for surgery.
Results:
Six hundred and two were analyzed including 60 (10 %) that required 7 days surgery. The CLAD - Modified with Biology (CLAD - MB) included: age > 45 years (OR = 1.64; + 1 point), an history of urological surgery (OR = 2.03; + 1 point), a pain score > 7/10 (OR = 2.16; + 1 point), a temperature > 37.8 °C (OR = 4.2; + 2 points), a negative dipstick for blood (OR = 1.53; + 1 point), a CRP ≥ 50 mg/mL (OR = 2.8; + 1 point), a leucocytes count ≥12 G/L (OR = 1.72; + 1 point) and an elevated creatinine (OR = 5.46; + 2 points). A CLAD - MB threshold of <1 had high sensitivity (98 % [91-100]) and low negative likelihood ratio (0.12 [0.02-0.83]).
Conclusion:
CLAD - MB has good prognostic ability for identify patients at low risk of 7-day surgery.
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