Appropriate Use Criterion May Reduce Unnecessary Imaging in Renal Colic

Appropriate use criterion (AUC) based on local best practice as electronic clinical decision support (CDS) may help reduce overuse of imaging among patients with suspected nephrolithiasis, according to a study published in the American Journal of Roentgenology.

Researchers from Brigham and Women’s Hospital in Boston, Massachusetts, performed a retrospective study to evaluate the impact of AUC for patients with renal colic who presented at the emergency room, based on local best practice. The researchers developed and implemented their own appropriate use criteria covering CT for this patient group. Patients were from a level I trauma center (the study site) or a local comparable hospital (the control site)

A total of 467 patients (194 from the study site) before AUC implementation and 306 (88 from the study site) after AUC implementation were included in the study. A team comprising physicians from emergency medicine, emergency radiology, and urology developed an AUC for patients younger than 50 years with a history of uncomplicated nephrolithiasis presenting with renal colic. There was no CDS alert for AUC-consistent CT of ureter requests, while the researchers were alerted to consider a trial of symptomatic control or discharge without CT.

Related article: Why Radiologists Should Care About Clinical Decision Support

A natural language processing tool mined ED notes for visits before AUC implementation (September 2010 to February 2012) and one year after AUC implementation (April 2013 to September 2014) for concept unique identifiers of flank tenderness or renal or ureteral pain.

The results showed that after implementation of the AUC, the study site's CT of ureter rate decreased from 23.7% (46/194 patients) to 14.8% (13/88 patients) but the rate at the control site remained unchanged, 49.8% (136/273 patients) versus 48.2% (105/218 patients).

The researchers concluded that by implementing an AUC based on local best practice as CDS, physicians may effectively reduce overuse of imaging among a subset of ED patients with renal colic who were not likely to have a complicated course or alternative dangerous diagnosis.