Ultrasonography versus computed tomography for suspected nephrolithiasis

R. Smith-Bindman, C. Aubin, J. Bailitz, R. N. Bengiamin, C. A. Camargo, J. Corbo, A. J. Dean, R. B. Goldstein, R. T. Griffey, G. D. Jay, T. L. Kang, D. R. Kriesel, O. J. Ma, M. Mallin, W. Manson, Joy Melnikow, Diana L Miglioretti, S. K. Miller, Lisa D Mills, J. R. Miner & 8 others M. Moghadassi, V. E. Noble, G. M. Press, M. L. Stoller, V. E. Valencia, J. Wang, R. C. Wang, S. R. Cummings

Research output: Contribution to journalArticle

258 Citations (Scopus)

Abstract

BACKGROUND There is a lack of consensus about whether the initial imaging method for patients with suspected nephrolithiasis should be computed tomography (CT) or ultrasonography.

Methods In this multicenter, pragmatic, comparative effectiveness trial, we randomly assigned patients 18 to 76 years of age who presented to the emergency department with suspected nephrolithiasis to undergo initial diagnostic ultrasonography performed by an emergency physician (point-of-care ultrasonography), ultrasonography performed by a radiologist (radiology ultrasonography), or abdominal CT. Subsequent management, including additional imaging, was at the discretion of the physician. We compared the three groups with respect to the 30-day incidence of high-risk diagnoses with complications that could be related to missed or delayed diagnosis and the 6-month cumulative radiation exposure. Secondary outcomes were serious adverse events, related serious adverse events (deemed attributable to study participation), pain (assessed on an 11-point visual-analogue scale, with higher scores indicating more severe pain), return emergency department visits, hospitalizations, and diagnostic accuracy.

Results A total of 2759 patients underwent randomization: 908 to point-of-care ultrasonography, 893 to radiology ultrasonography, and 958 to CT. The incidence of high-risk diagnoses with complications in the first 30 days was low (0.4%) and did not vary according to imaging method. The mean 6-month cumulative radiation exposure was significantly lower in the ultrasonography groups than in the CT group (P<0.001). Serious adverse events occurred in 12.4% of the patients assigned to point-of-care ultrasonography, 10.8% of those assigned to radiology ultrasonography, and 11.2% of those assigned to CT (P = 0.50). Related adverse events were infrequent (incidence, 0.4%) and similar across groups. By 7 days, the average pain score was 2.0 in each group (P = 0.84). Return emergency department visits, hospitalizations, and diagnostic accuracy did not differ significantly among the groups.

Conclusions Initial ultrasonography was associated with lower cumulative radiation exposure than initial CT, without significant differences in high-risk diagnoses with complications, serious adverse events, pain scores, return emergency department visits, or hospitalizations.

Original languageEnglish (US)
Pages (from-to)1100-1110
Number of pages11
JournalNew England Journal of Medicine
Volume371
Issue number12
DOIs
StatePublished - Sep 18 2014

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Nephrolithiasis
Ultrasonography
Tomography
Point-of-Care Systems
Hospital Emergency Service
Radiology
Pain
Hospitalization
Incidence
Physicians
Delayed Diagnosis
Random Allocation
Visual Analog Scale
Consensus
Emergencies

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Smith-Bindman, R., Aubin, C., Bailitz, J., Bengiamin, R. N., Camargo, C. A., Corbo, J., ... Cummings, S. R. (2014). Ultrasonography versus computed tomography for suspected nephrolithiasis. New England Journal of Medicine, 371(12), 1100-1110. https://doi.org/10.1056/NEJMoa1404446

Ultrasonography versus computed tomography for suspected nephrolithiasis. / Smith-Bindman, R.; Aubin, C.; Bailitz, J.; Bengiamin, R. N.; Camargo, C. A.; Corbo, J.; Dean, A. J.; Goldstein, R. B.; Griffey, R. T.; Jay, G. D.; Kang, T. L.; Kriesel, D. R.; Ma, O. J.; Mallin, M.; Manson, W.; Melnikow, Joy; Miglioretti, Diana L; Miller, S. K.; Mills, Lisa D; Miner, J. R.; Moghadassi, M.; Noble, V. E.; Press, G. M.; Stoller, M. L.; Valencia, V. E.; Wang, J.; Wang, R. C.; Cummings, S. R.

In: New England Journal of Medicine, Vol. 371, No. 12, 18.09.2014, p. 1100-1110.

Research output: Contribution to journalArticle

Smith-Bindman, R, Aubin, C, Bailitz, J, Bengiamin, RN, Camargo, CA, Corbo, J, Dean, AJ, Goldstein, RB, Griffey, RT, Jay, GD, Kang, TL, Kriesel, DR, Ma, OJ, Mallin, M, Manson, W, Melnikow, J, Miglioretti, DL, Miller, SK, Mills, LD, Miner, JR, Moghadassi, M, Noble, VE, Press, GM, Stoller, ML, Valencia, VE, Wang, J, Wang, RC & Cummings, SR 2014, 'Ultrasonography versus computed tomography for suspected nephrolithiasis', New England Journal of Medicine, vol. 371, no. 12, pp. 1100-1110. https://doi.org/10.1056/NEJMoa1404446
Smith-Bindman R, Aubin C, Bailitz J, Bengiamin RN, Camargo CA, Corbo J et al. Ultrasonography versus computed tomography for suspected nephrolithiasis. New England Journal of Medicine. 2014 Sep 18;371(12):1100-1110. https://doi.org/10.1056/NEJMoa1404446
Smith-Bindman, R. ; Aubin, C. ; Bailitz, J. ; Bengiamin, R. N. ; Camargo, C. A. ; Corbo, J. ; Dean, A. J. ; Goldstein, R. B. ; Griffey, R. T. ; Jay, G. D. ; Kang, T. L. ; Kriesel, D. R. ; Ma, O. J. ; Mallin, M. ; Manson, W. ; Melnikow, Joy ; Miglioretti, Diana L ; Miller, S. K. ; Mills, Lisa D ; Miner, J. R. ; Moghadassi, M. ; Noble, V. E. ; Press, G. M. ; Stoller, M. L. ; Valencia, V. E. ; Wang, J. ; Wang, R. C. ; Cummings, S. R. / Ultrasonography versus computed tomography for suspected nephrolithiasis. In: New England Journal of Medicine. 2014 ; Vol. 371, No. 12. pp. 1100-1110.
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abstract = "BACKGROUND There is a lack of consensus about whether the initial imaging method for patients with suspected nephrolithiasis should be computed tomography (CT) or ultrasonography.Methods In this multicenter, pragmatic, comparative effectiveness trial, we randomly assigned patients 18 to 76 years of age who presented to the emergency department with suspected nephrolithiasis to undergo initial diagnostic ultrasonography performed by an emergency physician (point-of-care ultrasonography), ultrasonography performed by a radiologist (radiology ultrasonography), or abdominal CT. Subsequent management, including additional imaging, was at the discretion of the physician. We compared the three groups with respect to the 30-day incidence of high-risk diagnoses with complications that could be related to missed or delayed diagnosis and the 6-month cumulative radiation exposure. Secondary outcomes were serious adverse events, related serious adverse events (deemed attributable to study participation), pain (assessed on an 11-point visual-analogue scale, with higher scores indicating more severe pain), return emergency department visits, hospitalizations, and diagnostic accuracy.Results A total of 2759 patients underwent randomization: 908 to point-of-care ultrasonography, 893 to radiology ultrasonography, and 958 to CT. The incidence of high-risk diagnoses with complications in the first 30 days was low (0.4{\%}) and did not vary according to imaging method. The mean 6-month cumulative radiation exposure was significantly lower in the ultrasonography groups than in the CT group (P<0.001). Serious adverse events occurred in 12.4{\%} of the patients assigned to point-of-care ultrasonography, 10.8{\%} of those assigned to radiology ultrasonography, and 11.2{\%} of those assigned to CT (P = 0.50). Related adverse events were infrequent (incidence, 0.4{\%}) and similar across groups. By 7 days, the average pain score was 2.0 in each group (P = 0.84). Return emergency department visits, hospitalizations, and diagnostic accuracy did not differ significantly among the groups.Conclusions Initial ultrasonography was associated with lower cumulative radiation exposure than initial CT, without significant differences in high-risk diagnoses with complications, serious adverse events, pain scores, return emergency department visits, or hospitalizations.",
author = "R. Smith-Bindman and C. Aubin and J. Bailitz and Bengiamin, {R. N.} and Camargo, {C. A.} and J. Corbo and Dean, {A. J.} and Goldstein, {R. B.} and Griffey, {R. T.} and Jay, {G. D.} and Kang, {T. L.} and Kriesel, {D. R.} and Ma, {O. J.} and M. Mallin and W. Manson and Joy Melnikow and Miglioretti, {Diana L} and Miller, {S. K.} and Mills, {Lisa D} and Miner, {J. R.} and M. Moghadassi and Noble, {V. E.} and Press, {G. M.} and Stoller, {M. L.} and Valencia, {V. E.} and J. Wang and Wang, {R. C.} and Cummings, {S. R.}",
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TY - JOUR

T1 - Ultrasonography versus computed tomography for suspected nephrolithiasis

AU - Smith-Bindman, R.

AU - Aubin, C.

AU - Bailitz, J.

AU - Bengiamin, R. N.

AU - Camargo, C. A.

AU - Corbo, J.

AU - Dean, A. J.

AU - Goldstein, R. B.

AU - Griffey, R. T.

AU - Jay, G. D.

AU - Kang, T. L.

AU - Kriesel, D. R.

AU - Ma, O. J.

AU - Mallin, M.

AU - Manson, W.

AU - Melnikow, Joy

AU - Miglioretti, Diana L

AU - Miller, S. K.

AU - Mills, Lisa D

AU - Miner, J. R.

AU - Moghadassi, M.

AU - Noble, V. E.

AU - Press, G. M.

AU - Stoller, M. L.

AU - Valencia, V. E.

AU - Wang, J.

AU - Wang, R. C.

AU - Cummings, S. R.

PY - 2014/9/18

Y1 - 2014/9/18

N2 - BACKGROUND There is a lack of consensus about whether the initial imaging method for patients with suspected nephrolithiasis should be computed tomography (CT) or ultrasonography.Methods In this multicenter, pragmatic, comparative effectiveness trial, we randomly assigned patients 18 to 76 years of age who presented to the emergency department with suspected nephrolithiasis to undergo initial diagnostic ultrasonography performed by an emergency physician (point-of-care ultrasonography), ultrasonography performed by a radiologist (radiology ultrasonography), or abdominal CT. Subsequent management, including additional imaging, was at the discretion of the physician. We compared the three groups with respect to the 30-day incidence of high-risk diagnoses with complications that could be related to missed or delayed diagnosis and the 6-month cumulative radiation exposure. Secondary outcomes were serious adverse events, related serious adverse events (deemed attributable to study participation), pain (assessed on an 11-point visual-analogue scale, with higher scores indicating more severe pain), return emergency department visits, hospitalizations, and diagnostic accuracy.Results A total of 2759 patients underwent randomization: 908 to point-of-care ultrasonography, 893 to radiology ultrasonography, and 958 to CT. The incidence of high-risk diagnoses with complications in the first 30 days was low (0.4%) and did not vary according to imaging method. The mean 6-month cumulative radiation exposure was significantly lower in the ultrasonography groups than in the CT group (P<0.001). Serious adverse events occurred in 12.4% of the patients assigned to point-of-care ultrasonography, 10.8% of those assigned to radiology ultrasonography, and 11.2% of those assigned to CT (P = 0.50). Related adverse events were infrequent (incidence, 0.4%) and similar across groups. By 7 days, the average pain score was 2.0 in each group (P = 0.84). Return emergency department visits, hospitalizations, and diagnostic accuracy did not differ significantly among the groups.Conclusions Initial ultrasonography was associated with lower cumulative radiation exposure than initial CT, without significant differences in high-risk diagnoses with complications, serious adverse events, pain scores, return emergency department visits, or hospitalizations.

AB - BACKGROUND There is a lack of consensus about whether the initial imaging method for patients with suspected nephrolithiasis should be computed tomography (CT) or ultrasonography.Methods In this multicenter, pragmatic, comparative effectiveness trial, we randomly assigned patients 18 to 76 years of age who presented to the emergency department with suspected nephrolithiasis to undergo initial diagnostic ultrasonography performed by an emergency physician (point-of-care ultrasonography), ultrasonography performed by a radiologist (radiology ultrasonography), or abdominal CT. Subsequent management, including additional imaging, was at the discretion of the physician. We compared the three groups with respect to the 30-day incidence of high-risk diagnoses with complications that could be related to missed or delayed diagnosis and the 6-month cumulative radiation exposure. Secondary outcomes were serious adverse events, related serious adverse events (deemed attributable to study participation), pain (assessed on an 11-point visual-analogue scale, with higher scores indicating more severe pain), return emergency department visits, hospitalizations, and diagnostic accuracy.Results A total of 2759 patients underwent randomization: 908 to point-of-care ultrasonography, 893 to radiology ultrasonography, and 958 to CT. The incidence of high-risk diagnoses with complications in the first 30 days was low (0.4%) and did not vary according to imaging method. The mean 6-month cumulative radiation exposure was significantly lower in the ultrasonography groups than in the CT group (P<0.001). Serious adverse events occurred in 12.4% of the patients assigned to point-of-care ultrasonography, 10.8% of those assigned to radiology ultrasonography, and 11.2% of those assigned to CT (P = 0.50). Related adverse events were infrequent (incidence, 0.4%) and similar across groups. By 7 days, the average pain score was 2.0 in each group (P = 0.84). Return emergency department visits, hospitalizations, and diagnostic accuracy did not differ significantly among the groups.Conclusions Initial ultrasonography was associated with lower cumulative radiation exposure than initial CT, without significant differences in high-risk diagnoses with complications, serious adverse events, pain scores, return emergency department visits, or hospitalizations.

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DO - 10.1056/NEJMoa1404446

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JO - New England Journal of Medicine

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