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Original Article Ultrasonography versus Computed Tomography for Suspected Nephrolithiasis Rebecca Smith-Bindman, M.D., Chandra Aubin, M.D., R.D.M.S., John Bailitz, M.D., Rimon N. Bengiamin, M.D., R.D.M.S., Carlos A.

Camargo, Jr., M.D., Dr.P.H., Jill Corbo, M.D., R.D.M.S., Anthony J. Dean, M.D., Ruth B. Goldstein, M.D., Richard T.

Griffey, M.D., M.P.H., Gregory D. Jay, M.D., Ph.D., Tarina L. Kang, M.D., Dana R. Kriesel, M.P.H., M.S., O. John Ma, M.D., Michael Mallin, M.D., William Manson, M.D., Joy Melnikow, M.D., M.P.H., Diana L.

Miglioretti, Ph.D., Sara K. Miller, M.D., R.D.M.S., Lisa D.

Mills, M.D., James R. Miner, M.D., Michelle Moghadassi, M.P.H., Vicki E. Noble, M.D., Gregory M. Press, M.D., Marshall L. Stoller, M.D., Victoria E. Valencia, M.P.H., Jessica Wang, M.D., Ralph C.

Wang, M.D., and Steven R. Cummings, M.D. N Engl J Med 2014; 371:1100-1110 DOI: 10.1056/NEJMoa1404446. Methods In this multicenter, pragmatic, comparative effectiveness trial, we randomly assigned patients 18 to 76 years of age who presented to the emergency department with suspected nephrolithiasis to undergo initial diagnostic ultrasonography performed by an emergency physician (point-of-care ultrasonography), ultrasonography performed by a radiologist (radiology ultrasonography), or abdominal CT. Subsequent management, including additional imaging, was at the discretion of the physician. We compared the three groups with respect to the 30-day incidence of high-risk diagnoses with complications that could be related to missed or delayed diagnosis and the 6-month cumulative radiation exposure. Secondary outcomes were serious adverse events, related serious adverse events (deemed attributable to study participation), pain (assessed on an 11-point visual-analogue scale, with higher scores indicating more severe pain), return emergency department visits, hospitalizations, and diagnostic accuracy.

Results A total of 2759 patients underwent randomization: 908 to point-of-care ultrasonography, 893 to radiology ultrasonography, and 958 to CT. The incidence of high-risk diagnoses with complications in the first 30 days was low (0.4%) and did not vary according to imaging method. The mean 6-month cumulative radiation exposure was significantly lower in the ultrasonography groups than in the CT group (P. Pain from nephrolithiasis is a common reason for emergency department visits in the United States. Abdominal computed tomography (CT) has become the most common initial imaging test for suspected nephrolithiasis because of its high sensitivity for the diagnosis of urinary stone disease. However, CT entails exposure to ionizing radiation with attendant long-term cancer risk, is associated with a high rate of incidental findings that can lead to inappropriate follow-up referral and treatment, and contributes to growing annual care costs for acute nephrolithiasis, which are currently approximately $2 billion in the United States. No evidence has shown that increased CT use, despite its higher sensitivity, is associated with improved patient outcomes.

To assess the effect of diagnostic imaging techniques on patient outcomes, we conducted a multicenter, randomized trial comparing ultrasonography with CT. Study Design and Randomization Study patients were recruited in 15 geographically diverse academic emergency departments, four of which were safety-net hospitals (Table S1 in the, available with the full text of this article at NEJM.org). Patients with suspected nephrolithiasis were randomly assigned, in a 1:1:1 ratio, to one of three imaging groups: ultrasonography performed by an emergency physician (point-of-care ultrasonography), ultrasonography performed by a radiologist (radiology ultrasonography), or abdominal CT. Patients were randomly assigned only during hours when all three imaging techniques were feasible. Randomization was performed with the use of the RANUNI function in SAS software at the study website. After assignment, the patients’ care during the emergency department visit at the time of enrollment was managed at the discretion of the treating physicians, including decisions about further imaging and the treatment and disposition of the patients. The and statistical analysis plan are available at NEJM.org. Jayam Telugu Mp3 Songs Free more.