HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text All Versions of this Article: 2252020101v1 225/2/441    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gottlieb, R. H. Articles by Messing, E. M. Search for Related Content PubMed PubMed Citation Articles by Gottlieb, R. H. Articles by Messing, E. M.

CT in Detecting Urinary Tract Calculi: Influence on Patient Imaging and Clinical Outcomes¹

¹ From the Depts of Radiology (R.H.G., J.L.S., S.L.V., L.S., R.E., D.D., T.C.L., I.M.), Urology (E.N.E., J.V.J., E.M.M.), and Neurology (R.G.H.); Emergency Dept (F.L.Z.); and Clin Research Ctr (W.J.D.), Univ of Rochester Medical Ctr, 601 Elmwood Ave, Box 648, Rochester, NY 14642; and Dept of Radiology, Hosp Univ of Pennsylvania, Philadelphia (A.T.T.). Received Feb 13, 2002; revision requested Apr 5; revision received Apr 22; accepted May 29. Supported in part by Div of Research Resources-GCRC grant 5M01 RR-00044 and Medical Ctr Insurance of Vermont. Address correspondence to R.H.G. (e-mail: ronald_gottlieb@urmc.rochester.edu).

PURPOSE: To determine changes in examination patterns and effectiveness of care since the introduction of unenhanced helical computed tomography (CT) for examination of patients presenting to the emergency department (ED) with symptoms of urinary tract calculi (UTC).

MATERIALS AND METHODS: Hospital clinical and radiology information systems were used to retrospectively identify patients presenting with UTC symptoms from January to December 1997 (before introduction of unenhanced CT) and from January to December 1999 (after introduction of unenhanced CT). Chart abstraction was used to confirm the identification of patients with presenting symptoms suggestive of UTC and assess patient outcomes. Two hundred sixty-five patients presented before (1997) and 602 after (1999) unenhanced CT was introduced. Distributions of dichotomous variables were compared between the 1997 and 1999 groups by using logistic regression. Means were compared between the groups by using analysis of variance and mean total numbers of imaging studies by using Poisson regression.

RESULTS: Total number of imaging studies increased by 26.7% per patient visit (P < .001). Rates of admission following the initial ED visit (13.7% in 1997 vs 13.4% in 1999), as well as percentage of patients who subsequently returned to the ED (12.0% in 1997 vs 13.7% in 1999) or subsequently were admitted to the hospital (4.5% in 1997 vs 5.3% in 1999) in the month following the initial ED visit, were similar between the two groups. Unsuspected unenhanced CT findings that could affect acute patient care were observed at 5.9% of examinations.

CONCLUSION: Use of imaging for suspected UTC has increased markedly since the introduction of unenhanced CT, with little effect on acute care of patients in the ED.

© RSNA, 2002

Index terms: Computed tomography (CT), clinical effectiveness • Computed tomography (CT), utilization • Kidney, calculi, 81.811 • Kidney, CT, 81.12111, 81.12112, 81.12115 • Radiology and radiologists, socioeconomic issues

This article has been cited by other articles:

				E. K. Paulson, C. Weaver, L. M. Ho, L. Martin, J. Li, J. Darsie, and D. P. Frush Conventional and Reduced Radiation Dose of 16-MDCT for Detection of Nephrolithiasis and Ureterolithiasis Am. J. Roentgenol., January 1, 2008; 190(1): 151 - 157. [Abstract] [Full Text] [PDF]

				S. Gurel, D. Akata, K. Gurel, M. N. Ozmen, and O. Akhan Correlation Between the Renal Resistive Index (RI) and Nonenhanced Computed Tomography in Acute Renal Colic: How Reliable Is the RI in Distinguishing Obstruction? J. Ultrasound Med., September 1, 2006; 25(9): 1113 - 1120. [Abstract] [Full Text] [PDF]

				R. H. Gottlieb Imaging for Whom: Patient or Physician? Am. J. Roentgenol., December 1, 2005; 185(6): 1399 - 1403. [Abstract] [Full Text] [PDF]

				A. Kirpalani, K. Khalili, S. Lee, and M. A. Haider Renal Colic: Comparison of Use and Outcomes of Unenhanced Helical CT for Emergency Investigation in 1998 and 2002 Radiology, August 1, 2005; 236(2): 554 - 558. [Abstract] [Full Text] [PDF]

				D. S. Katz, M. Jain, M. J. Lane, E. M. Meiner, S. Bhalla, C. O. Menias, and C. M. Rucker Invited Commentary * Authors' Response RadioGraphics, October 1, 2004; 24(suppl_1): S28 - S33. [Full Text] [PDF]