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Objective: The purpose of this study was to validate an algorithm recommended by current literature for the patients with acute flank pain and evaluate the validity of bedside ultrasonography (US) performed by emergency physicians (EP) as a part of this algorithm., Materials and Methods: This prospective validation study was carried out over a 5 month period in a tertiary care hospital adult emergency department (ED) with annual attendance of 55,000. Adult patients presenting to the ED with unilateral acute flank pain during the study period were enrolled into the study consecutively. Oral consent was obtained after the protocol was briefly explained to the patient and before the administration of analgesia. A protocol form was recorded for each patient enrolled into the study, and patients were followed up under the guidance of a previously designated algorithm in the ED. Data were analysed with SPSS software. The chi2 test was used to compare the dichotomised data of patients, diagnosed with and without stones, and to select the significant parameters to be used in the logistic regression., Results: Of the 227 patients enrolled, 176 were proven to have urinary tract stones. There were 122 patients discharged from ED without further investigation except urinalysis and bedside US. Of these 122 directly discharged patients, 99 had a urinary stone, and the others did not have a life threatening disorder. Four of the 227 patients were admitted to the hospital. The remaining 51 patients did not have stones detected, and their pain subsided. Having a previous history of stones, radiation of pain to the groin, accompanying nausea, and detection of pelvicalyceal dilatation using bedside US performed by the EPs were found to be the most significant parameters in determining urinary stones in logistic regression analysis. Sensitivity and specificity of these parameters were: previous history of stones 59% and 66%, radiating pain to the groin 68% and 49%, nausea 71% and 51%, and detection of pelvicalyceal dilatation by bedside US 81% and 37%., Conclusion: Bedside US performed by EPs could be used safely in the evaluation of patients with acute flank pain as a part of a clinical algorithm. Previous history of urinary stones, radiation of pain to the groin, accompanying nausea. and detection of pelvicalyceal dilatation are major parameters and symptoms of urinary stone disease, and could be used in the algorithms.

We determined the diagnostic value of urinalysis and plain films in patients with suspected renal colic presenting to an emergency department (ED). Over a 1-year period, 138 patients presented to the ED during the daytime with suspected renal colic, but for technical reasons the diagnostic modalities used in the study could be completed for only 99 patients, and 34 patients were lost to follow-up. A urinalysis; kidney, ureter, and bladder film; and spiral computed tomography (CT) were performed on each patient. The presence of urinary tract stones was determined by their definite presence on helical CT and/or passage of a stone on clinical follow-up (average follow-up = 3 months). A urinary stone was visualized on spiral CT or passed in the urine in 54 of the patients. Using helical CT findings or passage of a stone as the gold standard, plain radiography had a sensitivity of 69% and specificity of 82%. Urinalysis had a sensitivity of 69% and specificity of 27%. The sensitivity increased to 89% if either test was positive, but the specificity remained low at 27%. The sensitivity and specificity of CT in the diagnosis of urinary stones was 91%. Urinalysis and plain films are much less accurate than helical CT for confirming the diagnosis of acute urolithiasis. Further evaluation of the clinical and cost-effectiveness of helical CT should be done to determine its role in the work-up of these patients., (Copyright 2003, Elsevier Science (USA). All rights reserved.))

Background and Objective: Comparison of the effectiveness of tramadol with meperidine given intravenously to emergency patients with suspected renal colic., Methods: A double-blind, randomized clinical trial was performed in the Emergency Department of a tertiary-care university hospital. Consecutive patients with suspected renal colic (n = 47) were randomized to receive intravenously an initial dose of tramadol 50 mg (n = 23) or meperidine 50 mg (n = 24). After 30 min, additional doses of meperidine 50 mg were given intravenously as a rescue medication in an open fashion. Pain relief was assessed using a 10 cm visual analogue scale, the primary outcomes being pain relief at 15 and 30 min after the analgesics. Secondary outcomes were the frequency of rescue meperidine use and the development of side-effects., Results: Visual analogue scale pain scores after 15 and 30 min decreased in both tramadol and meperidine groups (P < 0.05). However, pain relief was better in the meperidine group at the 15 and 30 min evaluations (P < 0.05). Only 11 patients (48%), initially receiving meperidine, needed more meperidine compared with 16 patients (67%) initially receiving tramadol. Both drugs were well tolerated with no adverse effects occurring in either group., Conclusions: Meperidine 50 mg was superior to tramadol 50 mg for acute pain relief in patients with suspected renal colic when given intravenously. Because many patients in both groups received supplemental meperidine and the response to tramadol alone cannot be predicted, clinicians may want to choose higher doses of meperidine alone or other alternative combinations.