12th WINFOCUS world congress on ultrasound in emergency and critical care

Gabriel Blecher1,2, Robert Meek1,2, Diana Egerton-Warburton1,2 1Monash Emergency Research Collaborative, Monash University, Clayton, Australia; 2Emergency Program, Monash Health, Monash Medical Centre, Clayton, Australia Correspondence: Gabriel Blecher, e-mail: gabriel.blecher@monashhealth.org Critical Ultrasound Journal 2016, 8(Suppl 1):A13 Purpose: To compare computed tomography urography (CTU) use between the Monash Clayton Emergency Department (ED), following the introduction of a revised guideline for suspected renal colic, aimed at restricting CTU use to those with higher likelihood of needing a urological intervention, and the Monash Dandenong ED, where the use of the current guideline was continued. Methods: A quasi-experimental cohort study was conducted on a consecutive series of eligible patients presenting to two Monash Health EDs from November 2015 until February 2016. The study site was Monash Clayton and the control site was Monash Dandenong. All patients who were aged 18 or over who presented to the emergency department with renal colic clinically suspected by the treating clinician were eligible for recruitment. A new imaging protocol was developed subsequent to prior work in our institution, which incorporated point-of-care ultrasound to detect hydronephrosis and AAA. CTU was performed for red flag presence or failure to achieve adequate analgesia. The protocol was promoted in medical and nursing education sessions solely at the Monash site prior to study commencement. Routine care was provided to all patients with suspected renal colic at the Monash Dandenong site. The primary outcome measure was the difference in the proportion of patients with suspected renal colic undergoing CTU between the two sites. Secondary outcomes include the following: 1. proportion of patients having CTU who have ureteric stones detected, 2. proportion of patients having CTU who have a urological intervention, 3. proportion of patients who return to ED, 4. time to urological intervention, 5. average radiation exposure per patient, 6. admission rates, and 7. ED length of stay (LOS). Results: A total of 325 encounters were recorded, 149 (45.9 %) at Monash and 176 (54.2 %) at Dandenong. 71.1 % were male and the mean age was 48 years. CTU was performed in 80 (53.7 %) Monash patients and in 132 (75.0 %) Dandenong patients (p < 0.001). The CTU was positive for calculus in 61 (76.3 %) Monash patients and in 83 (62.9 %) Dandenong patients (p = 0.043). The median radiation dose was 2.6 mSv in Monash patients and 4.0 mSv in Dandenong patients (p < 0.001). Urological intervention occurred in 10 (12.4 %) Monash and 13 (11.4 %) Dandenong patients (p = 0.84). Conclusions: A new ultrasound-first imaging protocol in renal colic successfully reduces CTU use, with an attendant drop in radiation dose and an increased proportion of CTU showing calculi.