Top

International Journal of Emergency Medicine

Published in:

Open Access 01-12-2018 | Original Research

A comparative, epidemiological study of acute renal colic presentations to emergency departments in Doha, Qatar, and Melbourne, Australia

Authors: Sameer A. Pathan, Biswadev Mitra, Zain A. Bhutta, Isma Qureshi, Elle Spencer, Asmaa A. Hameed, Sana Nadeem, Ramsha Tahir, Shahzad Anjum, Peter A. Cameron

Published in: International Journal of Emergency Medicine | Issue 1/2018

Abstract

Background

This study aimed to compare the epidemiology, clinical presentations, management, and outcomes of renal colic presentations in two major academic centers from geographically diverse populations: Qatar (a country in the Afro-Asian stone belt) and South-Eastern Australia (not within a stone belt).

Methods

We undertook a retrospective cohort study of patients with renal colic who presented to the Hamad General Hospital Emergency Department (HGH-ED), Qatar, and The Alfred ED, Melbourne, Australia, during a period of 1 year from August 1, 2012, to July 31, 2013. Cases were identified using ICD-9-CM codes, and an electronic template was used to record the data on predefined clinical variables.

Results

A total of 12,223 from the HGH-ED and 384 from The Alfred ED were identified as renal colic presentations during the study period. The rate of renal colic presentations at the HGH-ED was 27.9 per 1000 ED visits compared to 6.7 per 1000 ED visits at The Alfred ED. Patients presenting to the HGH-ED were significantly younger [34.9 years (29.0–43.4) than The Alfred ED [48 years (37–60); P < 0.001].

The median stone size was larger in the HGH-ED group [6 (4–8) mm] versus The Alfred ED group [4 (3–6) mm, P < 0.001]. The intervention rate in the stone-positive population was significantly higher in the HGH-ED group as opposed to The Alfred ED group (38.7 versus 11.9%, P < 0.001). At the time of discharge, The Alfred ED group received fewer analgesic prescriptions (55.8 versus 83.5%, P < 0.001) and more tamsulosin prescriptions (25.3 versus 11.7%, P < 0.001).

Conclusions

Renal colic presentations to the HGH-ED, Qatar, were younger, with larger stone size mostly located in the lower ureter, compared to The Alfred ED, Melbourne, Australia. The findings suggest that the benefits of treatment including medical expulsion therapy will vary between the two populations. Differences in epidemiology and patient mix should be considered while tailoring strategies for effective management of patients with renal colic in a given setting.

Fisang C, Anding R, Muller SC, Latz S, Laube N. Urolithiasis—an interdisciplinary diagnostic, therapeutic and secondary preventive challenge. Deutsches Arzteblatt international. 2015;112(6):83–91.PubMedPubMedCentral

Ghani KR, Roghmann F, Sammon JD, Trudeau V, Sukumar S, Rahbar H, et al. Emergency department visits in the United States for upper urinary tract stones: trends in hospitalization and charges. J Urol. 2014;191(1):90–6.CrossRefPubMed

Elder JW, Delgado MK, Chung BI, Pirrotta EA, Wang NE. Variation in the intensity of care for patients with uncomplicated renal colic presenting to U.S. emergency departments. The Journal of emergency medicine. 2016;51(6):628–35.CrossRefPubMed

Lopez M, Hoppe B. History, epidemiology and regional diversities of urolithiasis. Pediatric nephrology (Berlin, Germany). 2010;25(1):49–59.CrossRef

Rizvi SA, Naqvi SA, Hussain Z, Hashmi A, Hussain M, Zafar MN, et al. The management of stone disease. BJU Int. 2002;89(Suppl 1):62–8.CrossRefPubMed

Robertson WG, Hughes H. Epidemiology of urinary stone disease in Saudi Arabia. In: Ryall R, Bais R, Marshall VR, Rofe AM, Smith LH, Walker VR, editors. Urolithiasis. 2nd ed. Boston, MA: Springer US; 1994. p. 453–5.

Pickard R, Starr K, MacLennan G, Lam T, Thomas R, Burr J, et al. Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial. Lancet (London, England). 2015;386(9991):341–9.CrossRef

Campschroer T, Zhu Y, Duijvesz D, Grobbee DE, Lock MT. Alpha-blockers as medical expulsive therapy for ureteral stones. Cochrane Database Syst Rev. 2014;2(4):CD008509. https://doi.org/10.1002/14651858.CD008509.pub2.

Pathan SA, Mitra B, Straney LD, Afzal MS, Anjum S, Shukla D, et al. Delivering safe and effective analgesia for management of renal colic in the emergency department: a double-blind, multigroup, randomised controlled trial. Lancet (London, England). 2016;387(10032):1999–2007.CrossRef

10.

Patatas K, Panditaratne N, Wah TM, Weston MJ, Irving HC. Emergency department imaging protocol for suspected acute renal colic: re-evaluating our service. Br J Radiol. 2012;85(1016):1118–22.CrossRefPubMedPubMedCentral

11.

Pernet J, Abergel S, Parra J, Ayed A, Bokobza J, Renard-Penna R, et al. Prevalence of alternative diagnoses in patients with suspected uncomplicated renal colic undergoing computed tomography: a prospective study. CJEM. 2015;17(1):67–73.CrossRefPubMed

12.

Westphalen AC, Hsia RY, Maselli JH, Wang R, Gonzales R. Radiological imaging of patients with suspected urinary tract stones: national trends, diagnoses, and predictors. Acad Emerg Med Off J Soc Acad Emerg Med. 2011;18(7):699–707.CrossRef

13.

Robertson WG. Stone formation in the Middle Eastern Gulf States: a review. Arab journal of urology. 2012;10(3):265–72.CrossRefPubMedPubMedCentral

14.

Blecher G, Meek R, Egerton-Warburton D, McCahy P, Bach C, Boulos D. Predictors for urologic intervention and alternate diagnoses in people having computed tomography urography for suspected renal colic. Emergency medicine Australasia : EMA. 2016;28(1):56–61.CrossRefPubMed

15.

Schoenfeld EM, Poronsky KE, Elia TR, Budhram GR, Garb JL, Mader TJ. Young patients with suspected uncomplicated renal colic are unlikely to have dangerous alternative diagnoses or need emergent intervention. West J Emerg Med. 2015;16(2):269–75.CrossRefPubMedPubMedCentral

16.

Schoenfeld EM, Pekow PS, Shieh MS, Scales CD, Jr., Lagu T, Lindenauer PK. The diagnosis and management of patients with renal colic across a sample of US hospitals: high CT utilization despite low rates of admission and inpatient urologic intervention. PLoS One. 2017;12(1):e0169160. https://doi.org/10.1371/journal.pone.0169160. eCollection 2017.

17.

Furyk JS, Chu K, Banks C, Greenslade J, Keijzers G, Thom O, et al. Distal ureteric stones and tamsulosin: a double-blind, placebo-controlled, randomized, multicenter trial. Ann Emerg Med. 2016;67(1):86–95. e2CrossRefPubMed

18.

Wang RC, Smith-Bindman R, Whitaker E, Neilson J, Allen IE, Stoller ML, et al. Effect of tamsulosin on stone passage for ureteral stones: a systematic review and meta-analysis. Ann Emerg Med. 2017;69(3):353–61. e3CrossRefPubMed

19.

Crozier J, Dean T, Klim S, Kelly AM. Predictors of admission for patients presenting to the emergency department with renal colic. Emergency medicine Australasia : EMA. 2015;27(1):86–7.CrossRefPubMed

20.

Pincus S, Macbean C, Taylor D. The effects of temperature, age and sex on presentations of renal colic in Melbourne, Australia. European journal of emergency medicine: official journal of the European Society for Emergency Medicine. 2010;17(6):328–31.CrossRef

21.

Daniels B, Gross CP, Molinaro A, Singh D, Luty S, Jessey R, et al. STONE PLUS: evaluation of emergency department patients with suspected renal colic, using a clinical prediction tool combined with point-of-care limited ultrasonography. Ann Emerg Med. 2016;67(4):439–48.CrossRefPubMed

22.

Bretlau T, Hansen RH, Thomsen HS. CT urography and hematuria: a retrospective analysis of 771 patients undergoing CT urography over a 1-year period. Acta radiologica (Stockholm, Sweden : 1987). 2015;56(7):890–6.CrossRef

Title: A comparative, epidemiological study of acute renal colic presentations to emergency departments in Doha, Qatar, and Melbourne, Australia
Authors: Sameer A. Pathan
Biswadev Mitra
Zain A. Bhutta
Isma Qureshi
Elle Spencer
Asmaa A. Hameed
Sana Nadeem
Ramsha Tahir
Shahzad Anjum
Peter A. Cameron
Publication date: 01-12-2018
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Emergency Medicine / Issue 1/2018
Print ISSN: 1865-1372
Electronic ISSN: 1865-1380
DOI: https://doi.org/10.1186/s12245-017-0160-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

A comparative, epidemiological study of acute renal colic presentations to emergency departments in Doha, Qatar, and Melbourne, Australia

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Older adults and technology: in telehealth, they may not be who you think they are

Emergency physician-performed ultrasound-guided nerve blocks in proximal femoral fractures provide safe and effective pain relief: a prospective observational study in The Netherlands

Elevated blood pressure and illness beliefs: a cross-sectional study of emergency department patients in Jamaica

A qualitative study of the determinants of adherence to NICE falls guideline in managing older fallers attending an emergency department

Estimation of weight in adults from height: a novel option for a quick bedside technique

Improving pediatric emergency department physicians’ adherence to clinical practice guidelines on the diagnosis and management of group A beta-hemolytic streptococcal pharyngitis—a cross-sectional study