Radiological Investigation in Acute Renal Colic Using CT KUB: Clinical Audit

 

Introduction
CT KUB is the investigation of choice when investigating acute renal colic in adult population (excluding pregnant women), as per iRefer RCR guidance1. It also falls in line with NICE guidance for acute renal colic2, British Association of Urological Surgeon (BAUS) guidelines for management of acute ureteric colic3, and European Association of Urology (EAUS) guidelines on urolithiasis4.

 

AIM
This audit assesses appropriate imaging investigation in presentation with acute renal colic, as well as the diagnostic yield of CT KUB scans in terms of renal calculi and alternative diagnoses.

 

Comparative Standard
CT KUB should be used to investigate acute renal colic in all adults >=18 years old (excluding pregnant women) unless the patient is a known recurrent stone former and had a CT KUB in the last 3 months then USS/KUB x-ray may be sufficient. 1,3
CT KUB should be performed within 24 hours of presentation. 2
According to published studies conducted at regional centers, CT KUB should detect calculi in 44-64% of patients, with alternate diagnoses noted in 6-18. 3-7

 

Results

Two audit cycles of CT KUB requests and reports were undertaken pre- and post-intervention (1st cycle n=77, 2nd cycle n=76) between September 2022 and August 2023.

 

Conclusions
The first cycle revealed minimal compliance, delay in scan time, along with omitting key details required for request requests (side of pain, examination findings, urine dip, previous imaging, relevant surgical history), and effective report in time.
As seen within the second cycle, our purpose intervention, developed through stakeholder input and strive for positive change, local requirements, and best practice guidelines, markedly improved requesting, reporting and timing of scans.
Efforts should be made to keep raising awareness and improve the quality of the care provided.

 

References
iREFER guidelines. U04. Suspected ureteric colic. RCR 2017 https://www.irefer.org.uk/guidelines
NICE guidance: Renal or ureteric colic – acute. Revised August 2020 https://cks.nice.org.uk/topics/renal-or-ureteric-colic-acute/
1.British Association of Urological Surgeons (BAUS) guidelines for management of acute ureteric colic,2017. https://www.baus.org.uk/professionals/baus_business/publications/133/guidelines_for_the_management_of_acute_ureteric_colic/
European Association of Urology (2014) Guidelines on urolithiasis.European Association of Urology. http://uroweb.org/guideline/urolithiasis/
Chowdhury FU, Kotwal S, Raghunathan G et al. Unenhanced multidetector CT (CT KUB) in the initial imaging of suspected acute renal colic: evaluating a new service. Clin Radiol. 2007 Oct;62(10):970-7.
Meagher T, Sukumar VP, Collingwood J, et al. Low dose computed tomography in suspected acute renal colic. Clin Radiol. 2001 Nov;56(11):873-6.
Greenwell TJ, Woodhams S, Denton ER, et al. One year's clinical experience with unenhanced spiral computed tomography for the assessment of acute loin pain suggestive of renal colic BJU Int. 2000 Apr;85(6):632-6.