Limit Computed Tomography (CT) Scanning in Suspected Renal Colic

Completed

Conditions studied: Renal Colic, Flank Pain, Back Pain

In brief

Computed tomography (CT) scanning is overused, expensive, and causes cancer. CT scan utilization in the U.S. has increased from an estimated 3 million CTs in 1980 to 62 million per year in 2007. From 2000 through 2006, Medicare spending on imaging more than doubled to $13.8 billion with advanced imaging such as CT scanning largely responsible. CT represents only 11% of radiologic examinations but is responsible for two-thirds of the ionizing radiation associated with medical imaging in the U.S. Recent estimates suggest that there will be 12.5 cancer deaths for every 10,000 CT scans. Renal colic is a common, non-life-threatening condition for which CT is overused. As many as 12% of people will have a kidney stone in their lifetime, and more than one million per year will present to the emergency department (ED). CT is now a first line test for renal colic, and is very accurate. However, 98% of kidney stones 5mm or smaller will pass spontaneously, and CT rarely alters management. A decision rule is needed to determine which patients with suspected renal colic require CT. While the signs and symptoms of renal colic have been shown to be predictable, no rule has yet been rigorously derived or validated to guide CT imaging in renal colic. A subset of patients with suspected renal colic may have a more serious diagnosis or a kidney stone that will require intervention; however the investigators maintain that clinical criteria, point of care ultrasound and plain radiography (when appropriate), will provide a more comparatively effective and safer approach by appropriately limiting imaging.

Key facts

Study ID

NCT01352676

Run by

Yale University

People needed

635

Starts

2011-05-01

Expected to finish

2014-03-01

Last updated by the study team

2020-03-06

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Patients who present to the adult YNHH ED and Shoreline Medical Center SMC ED who are
• 18 years or older,
• renal colic is suspected upon presentation to the ED suggested by flank pain, back pain, abdominal pain, and/or hematuria, and
• the physician intends to order a CT FPP study for suspicion of a kidney stone. Members of all ethnic and racial groups are eligible.

You may not qualify if…

• Patients will be excluded for any one of the following reasons: patients that are
• pregnant
• prisoners
• unable or unwilling to consent (including non-English speaking) and
• with a history or physical evidence of recent trauma.

Where it is running

• Shoreline Medical Center — Guilford, Connecticut, United States
• Yale University, Emergency Department — New Haven, Connecticut, United States

Full record on ClinicalTrials.gov

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