Initial Sonography OK for Nephrolithiasis Diagnosis
(HealthDay News) — No significant difference in outcomes is observed between the use of ultrasonography or computed tomography (CT) for suspected nephrolithiasis, according to research published in the September 18 issue of the New England Journal of Medicine.
Rebecca Smith-Bindman, MD, of the University of California in San Francisco, and colleagues conducted a multicenter, pragmatic, comparative effectiveness trial of patients aged 18–76 years. Patients who presented to the emergency department with suspected nephrolithiasis were randomly assigned to receive initial diagnostic imaging with point-of-care ultrasonography (908 patients), radiology ultrasonography (893 patients), or CT (958 patients).
The researchers found that the incidence of high-risk diagnoses with complications in the first 30 days was low (0.4%) and did not differ according to imaging method. The ultrasonography groups had a significantly lower mean six-month cumulative radiation exposure than the CT group (P<0.001). No significant differences (P=0.50) were observed in the rate of serious adverse events for those receiving point-of-care ultrasonography (12.4%), radiology ultrasonography (10.8%), or CT (11.2%). Diagnostic accuracy, return visits to the emergency department, and hospitalizations did not differ significantly between the groups.
"On the basis of the study findings, it is reasonable for a physician to use ultrasonography as the initial imaging method for a patient presenting to the emergency department with suspected nephrolithiasis, remembering that additional imaging studies should be used when clinically indicated," writes the author of an accompanying editorial.