Can resident-performed POCUS and clinical predictors effectively risk-stratify emergency department patients with confirmed renal colic?
Microscopic hematuria linked to nearly 4-fold higher odds of confirmed hydronephrosis
Can resident-performed POCUS and clinical predictors effectively risk-stratify emergency department patients with confirmed renal colic?
Universal reliance on non-contrast computed tomography (NCCT KUB) for suspected renal colic contributes to emergency department (emergency department) overcrowding and significant radiation exposure.
This study evaluates the diagnostic performance of resident-performed point-of-care ultrasound (point-of-care ultrasound) alongside clinical and laboratory markers to establish an early multi-modal risk-stratification framework for managing patients with confirmed urolithiasis.
We conducted a retrospective observational cohort study of 313 consecutive patients with CT-confirmed urolithiasis at a tertiary-care emergency department over six months.
microscopic hematuria nearly quadruples the odds of confirmed hydronephrosis
Documented resident-performed point-of-care ultrasound achieved a high sensitivity of 91.1% for identifying hydronephrosis against CT imaging, but displayed a critically low specificity of 21.4%.
Microscopic hematuria operated at an extremely high baseline prevalence of 84.4% (n = 255 of 302 patients with urinalysis) across the cohort.
Resident-performed point-of-care ultrasound achieved a PPV of 89.3% alongside its high sensitivity, reinforcing its utility as a rule-in adjunct.
A secondary bivariate analysis linked elevated serum creatinine (> 1.4 mg/dL) to acute inpatient resource utilization (p <.001).
While resident-performed point-of-care ultrasound is a sensitive but poorly specific tool for detecting hydronephrosis, it cannot safely guide disposition in isolation.
Its clinical value lies in integration: when combined with key clinical red flags and secondary biochemical markers, it enables a structured, multi-modal approach to risk stratification that is practical and radiation-sparing in a high-volume emergency setting.
Prospective multicenter trials are needed to validate this framework in pre-imaging triage settings.