Although it doesn't address the index visit, your listener can rest easy that ACEP guidelines recommend against CT scan for patients under the age of 50 with a history of kidney stones presenting with symptoms consistant with that diagnosis.
Great point Dallas! And I think the literature we have now would support extending that thought process to the index visit as well, assuming the patient does not have high risk features.
Agreed with the key points. Since you suggest ct for high risk patients, I assume you mean ct with contrast? I guess this means no more non con CT’s for stones.
I think the addition of contrast needs to be patient specific. These higher risk patients can still have kidney stones, and non-contrast CT would probably be best for that diagnosis. Personally, I use a combination of my suspicion for stone in combination with a UA for blood to help me decide to add contrast or not.
In a straightforward renal colic presentation, I sometimes wonder to myself, "Is this ultrasound result going to alter my management?". No hydro but with a good story and hematuria = pain meds. mild-moderate hydro = pain meds. severe hydro = pain meds. This is oversimplifying it but do you get what I'm saying? Anyone else with me? This isn't my actual practice but I do find a kidney stone workup very unexciting when I realize 95-99% of the time my management will be unchanged regardless.
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Dallas H. - May 9, 2018 6:40 AM
Although it doesn't address the index visit, your listener can rest easy that ACEP guidelines recommend against CT scan for patients under the age of 50 with a history of kidney stones presenting with symptoms consistant with that diagnosis.
http://www.choosingwisely.org/clinician-lists/acep-ct-of-abdomen-and-pelvis-for-ed-patients-under-50/
Michael M. - May 9, 2018 12:34 PM
Great point Dallas! And I think the literature we have now would support extending that thought process to the index visit as well, assuming the patient does not have high risk features.
NJ - May 11, 2018 10:19 AM
Agreed with the key points. Since you suggest ct for high risk patients, I assume you mean ct with contrast? I guess this means no more non con CT’s for stones.
Michael M. - May 11, 2018 9:54 PM
I think the addition of contrast needs to be patient specific. These higher risk patients can still have kidney stones, and non-contrast CT would probably be best for that diagnosis. Personally, I use a combination of my suspicion for stone in combination with a UA for blood to help me decide to add contrast or not.
Jackson H. - June 18, 2018 4:10 AM
In a straightforward renal colic presentation, I sometimes wonder to myself, "Is this ultrasound result going to alter my management?". No hydro but with a good story and hematuria = pain meds. mild-moderate hydro = pain meds. severe hydro = pain meds. This is oversimplifying it but do you get what I'm saying? Anyone else with me? This isn't my actual practice but I do find a kidney stone workup very unexciting when I realize 95-99% of the time my management will be unchanged regardless.