Begin main content

Computed Tomography Imaging for the Diagnosis of Renal Colic: A Review of Clinical and Cost-Effectiveness

Last updated: November 14, 2014
Project Number: RC0605-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Report in Brief

Context
The term "renal colic" is used to describe the severe pain caused when kidney stones have moved from the kidneys into the ureter (a tube that goes from the kidney to the bladder). This pain is often felt in the side and back. But when a patient visits the emergency department with severe side and back pain, renal colic is only one possible diagnosis. Two examples of other diagnoses are ectopic pregnancy and kidney infection. Computed tomography (CT) is frequently used to help determine whether the pain is due to renal colic.

Technology
CT uses X-rays to create images of bones and soft tissues inside the body. CT exposes the patient to radiation, which can be a concern in some patients, such as children and pregnant women. There are alternatives to CT that can minimize or avoid radiation. Low-dose CT minimizes the radiation exposure and portable ultrasound uses high-frequency sound waves to produce images of structures inside the body. These technologies may not be as accurate as standard CT when the kidney stones are small.

Issue
A review of the clinical and cost-effectiveness of CT compared with portable ultrasounds for diagnosing patients with renal colic in the emergency department will help inform decisions on how best to diagnose these patients.

Methods
A limited literature search was conducted of key resources, and titles and abstracts of the retrieved publications were reviewed. Full-text publications were evaluated for final article selection according to predetermined selection criteria (population, intervention, comparator, outcomes, and study designs).

Results
The literature search identified 553 citations, with 1 additional article identified from other sources. After screening the abstracts, 2 articles met the criteria for inclusion in this review. Both articles reported on the same randomized controlled trial.

Key Messages

  • Patients undergoing CT and portable ultrasound experience similar complication rates from delayed or missed diagnoses of renal colic (based on one recent study).
  • No evidence was found on the cost-effectiveness of using CT compared with portable ultrasound to diagnose renal colic in an emergency setting.

Question

  1. What is the clinical effectiveness of computed tomography (CT) imaging for the diagnosis of patients with renal colic due to kidney stones?
  2. What is the cost-effectiveness of CT imaging for the diagnosis of patients with renal colic due to kidney stones?

Key Message

Limited evidence from one randomized controlled trial suggested that point-of-care ultrasonography and computerized tomography had similar effects on various patient outcomes such as the 30-day incidence of complications or serious adverse events resulting from missed or delayed diagnosis and cumulative radiation exposure, in patients with suspected urolithiasis in the emergency department setting. No economic evaluations were identified to examine the cost-effectiveness of the two technologies in the study population.