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Background <p>Universal reliance on non-contrast computed tomography (NCCT KUB) for suspected renal colic contributes to emergency department (ED) overcrowding and significant radiation exposure. This study evaluates the diagnostic performance of resident-performed point-of-care ultrasound (POCUS) alongside clinical and laboratory markers to establish an early multi-modal risk-stratification framework for managing patients with confirmed urolithiasis.</p> Methods <p>We conducted a retrospective observational cohort study of 313 consecutive patients with CT-confirmed urolithiasis at a tertiary-care ED over six months. We assessed the diagnostic performance of resident-performed POCUS for hydronephrosis detection against CT as the reference standard, and used multivariable logistic regression to identify independent clinical predictors of CT-confirmed hydronephrosis.</p> Results <p>Documented resident-performed POCUS achieved a high sensitivity of 91.1% for identifying hydronephrosis against CT imaging, but displayed a critically low specificity of 21.4%. Microscopic hematuria operated at an extremely high baseline prevalence of 84.4% (<i>n</i> = 255 of 302 patients with urinalysis) across the cohort. Multivariable logistic regression identified three independent predictors of CT-confirmed hydronephrosis: microscopic hematuria (OR = 3.91, 95% CI [1.85, 8.23], <i>p</i> &lt;.001), nausea or vomiting (OR = 3.29, 95% CI [1.27, 8.56], <i>p</i> =.015), and female sex (OR = 0.34, 95% CI [0.17, 0.68], <i>p</i> =.002). Resident-performed POCUS achieved a PPV of 89.3% alongside its high sensitivity, reinforcing its utility as a rule-in adjunct. A secondary bivariate analysis linked elevated serum creatinine (&gt; 1.4&#xa0;mg/dL) to acute inpatient resource utilization (<i>p</i> &lt;.001).</p> Conclusion <p>While resident-performed POCUS is a sensitive but poorly specific tool for detecting hydronephrosis, it cannot safely guide disposition in isolation. Its clinical value lies in integration: when combined with key clinical red flags and secondary biochemical markers, it enables a structured, multi-modal approach to risk stratification that is practical and radiation-sparing in a high-volume emergency setting. Prospective multicenter trials are needed to validate this framework in pre-imaging triage settings.</p>

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Can resident-performed POCUS and clinical predictors effectively risk-stratify emergency department patients with confirmed renal colic?

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月6日

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  • Mohannad Alghamdi,
  • Dunya Alfaraj,
  • Laila Buarish,
  • Maram Busuhail,
  • Abdulrazzag Alharbi,
  • Khaled Alharthi,
  • Abdullah Alotaibi,
  • Talal Albogami,
  • Abdulaziz Alsaleh,
  • Arwaa Haji,
  • Thamir AlSayed

摘要

Background

Universal reliance on non-contrast computed tomography (NCCT KUB) for suspected renal colic contributes to emergency department (ED) overcrowding and significant radiation exposure. This study evaluates the diagnostic performance of resident-performed point-of-care ultrasound (POCUS) alongside clinical and laboratory markers to establish an early multi-modal risk-stratification framework for managing patients with confirmed urolithiasis.

Methods

We conducted a retrospective observational cohort study of 313 consecutive patients with CT-confirmed urolithiasis at a tertiary-care ED over six months. We assessed the diagnostic performance of resident-performed POCUS for hydronephrosis detection against CT as the reference standard, and used multivariable logistic regression to identify independent clinical predictors of CT-confirmed hydronephrosis.

Results

Documented resident-performed POCUS achieved a high sensitivity of 91.1% for identifying hydronephrosis against CT imaging, but displayed a critically low specificity of 21.4%. Microscopic hematuria operated at an extremely high baseline prevalence of 84.4% (n = 255 of 302 patients with urinalysis) across the cohort. Multivariable logistic regression identified three independent predictors of CT-confirmed hydronephrosis: microscopic hematuria (OR = 3.91, 95% CI [1.85, 8.23], p <.001), nausea or vomiting (OR = 3.29, 95% CI [1.27, 8.56], p =.015), and female sex (OR = 0.34, 95% CI [0.17, 0.68], p =.002). Resident-performed POCUS achieved a PPV of 89.3% alongside its high sensitivity, reinforcing its utility as a rule-in adjunct. A secondary bivariate analysis linked elevated serum creatinine (> 1.4 mg/dL) to acute inpatient resource utilization (p <.001).

Conclusion

While resident-performed POCUS is a sensitive but poorly specific tool for detecting hydronephrosis, it cannot safely guide disposition in isolation. Its clinical value lies in integration: when combined with key clinical red flags and secondary biochemical markers, it enables a structured, multi-modal approach to risk stratification that is practical and radiation-sparing in a high-volume emergency setting. Prospective multicenter trials are needed to validate this framework in pre-imaging triage settings.