Imaging patients with renal colic: a comparative analysis of the impact of non-contrast helical computed tomography versus intravenous pyelography on the speed of patient processing in the Emergency Department.

Hdl Handle:
http://hdl.handle.net/10147/207253
Title:
Imaging patients with renal colic: a comparative analysis of the impact of non-contrast helical computed tomography versus intravenous pyelography on the speed of patient processing in the Emergency Department.
Authors:
Quirke, M; Divilly, F; O'Kelly, P; Winder, S; Gilligan, P
Affiliation:
Emergency Department, Beaumont Hospital, Beaumont Road, PO BOX 1297, Dublin 9,, Ireland. mmmquirke@hotmail.com
Citation:
Emerg Med J. 2011 Mar;28(3):197-200. Epub 2010 Jun 26.
Journal:
Emergency medicine journal : EMJ
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207253
DOI:
10.1136/emj.2009.084806
PubMed ID:
20581407
Abstract:
INTRODUCTION: Non-contrast helical CT (NHCT) became the procedure of choice for investigating Emergency Department (ED) patients presenting with suspected renal colic at Beaumont Hospital, Dublin, in 2008. The impact of NHCT on waiting times and patient management was compared with intravenous pyelography (IVP). METHODS: A retrospective, comparative cohort analysis of 95 patients who had IVP and 109 patients who had NHCT was performed. Length of ED stay from time of scan ordering to referral or discharge was analysed relative to time of day and scan result. RESULTS: Patients having NHCT who attended between 00:00-08:00 h, had a twofold longer length of stay than those who had IVP between the same hours (median 7.07 h vs 3.03 h, p=0.0294). The length of ED stay for patients attending between 08:00 and 24:00 h was similar in both groups. The presence of urolithiasis did not impact on length of stay. A significant alternate/incidental diagnosis was reported in 28 patients having NHCT, of which 12 were cancerous growths. CONCLUSION: NHCT allows for the detection of incidental/alternate diagnoses that may not be otherwise detected in patients with renal colic. Compared to IVP, NHCT has not impacted positively on the speed of patient processing in the ED under study. For patients presenting after midnight, it is associated with over a twofold longer length of stay from the time of scan ordering to referral or discharge. This leads to prolonged patient stays in the ED, and as such contributes to overcrowding.
Language:
eng
MeSH:
Adolescent; Adult; Aged; Aged, 80 and over; Contrast Media/*diagnostic use; Efficiency, Organizational; Emergency Service, Hospital; Female; Humans; Incidental Findings; Ireland; *Length of Stay; Male; Middle Aged; Renal Colic/etiology/*radiography; Retrospective Studies; Time Factors; *Tomography, Spiral Computed; *Urography; Urolithiasis/complications/radiography
ISSN:
1472-0213 (Electronic); 1472-0205 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorQuirke, Men_GB
dc.contributor.authorDivilly, Fen_GB
dc.contributor.authorO'Kelly, Pen_GB
dc.contributor.authorWinder, Sen_GB
dc.contributor.authorGilligan, Pen_GB
dc.date.accessioned2012-02-01T10:03:10Z-
dc.date.available2012-02-01T10:03:10Z-
dc.date.issued2012-02-01T10:03:10Z-
dc.identifier.citationEmerg Med J. 2011 Mar;28(3):197-200. Epub 2010 Jun 26.en_GB
dc.identifier.issn1472-0213 (Electronic)en_GB
dc.identifier.issn1472-0205 (Linking)en_GB
dc.identifier.pmid20581407en_GB
dc.identifier.doi10.1136/emj.2009.084806en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207253-
dc.description.abstractINTRODUCTION: Non-contrast helical CT (NHCT) became the procedure of choice for investigating Emergency Department (ED) patients presenting with suspected renal colic at Beaumont Hospital, Dublin, in 2008. The impact of NHCT on waiting times and patient management was compared with intravenous pyelography (IVP). METHODS: A retrospective, comparative cohort analysis of 95 patients who had IVP and 109 patients who had NHCT was performed. Length of ED stay from time of scan ordering to referral or discharge was analysed relative to time of day and scan result. RESULTS: Patients having NHCT who attended between 00:00-08:00 h, had a twofold longer length of stay than those who had IVP between the same hours (median 7.07 h vs 3.03 h, p=0.0294). The length of ED stay for patients attending between 08:00 and 24:00 h was similar in both groups. The presence of urolithiasis did not impact on length of stay. A significant alternate/incidental diagnosis was reported in 28 patients having NHCT, of which 12 were cancerous growths. CONCLUSION: NHCT allows for the detection of incidental/alternate diagnoses that may not be otherwise detected in patients with renal colic. Compared to IVP, NHCT has not impacted positively on the speed of patient processing in the ED under study. For patients presenting after midnight, it is associated with over a twofold longer length of stay from the time of scan ordering to referral or discharge. This leads to prolonged patient stays in the ED, and as such contributes to overcrowding.en_GB
dc.language.isoengen_GB
dc.subject.meshAdolescenten_GB
dc.subject.meshAdulten_GB
dc.subject.meshAgeden_GB
dc.subject.meshAged, 80 and overen_GB
dc.subject.meshContrast Media/*diagnostic useen_GB
dc.subject.meshEfficiency, Organizationalen_GB
dc.subject.meshEmergency Service, Hospitalen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshIncidental Findingsen_GB
dc.subject.meshIrelanden_GB
dc.subject.mesh*Length of Stayen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshRenal Colic/etiology/*radiographyen_GB
dc.subject.meshRetrospective Studiesen_GB
dc.subject.meshTime Factorsen_GB
dc.subject.mesh*Tomography, Spiral Computeden_GB
dc.subject.mesh*Urographyen_GB
dc.subject.meshUrolithiasis/complications/radiographyen_GB
dc.titleImaging patients with renal colic: a comparative analysis of the impact of non-contrast helical computed tomography versus intravenous pyelography on the speed of patient processing in the Emergency Department.en_GB
dc.contributor.departmentEmergency Department, Beaumont Hospital, Beaumont Road, PO BOX 1297, Dublin 9,, Ireland. mmmquirke@hotmail.comen_GB
dc.identifier.journalEmergency medicine journal : EMJen_GB
dc.description.provinceLeinster-
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