This comparative effectiveness research article attracted a lot of attention, and has been covered in by the #UroJC crew (who run an extremely successful, asynchronous, discussion over 48 hours) in addition to the #NephJC team. A Storify of the #UroJC discussion was created by Dr. Joel Topf @kidney_boy and is available here.
In addition, this Tuesday the #NephJC discussion took place, and attracted a few urologists to the mix, thus enriching the conversation. The concern with CT scans is increased radiation exposure, which can result in higher risk of cancer (up to 24% in one paper). Many patients with recurrent stones (or conditions like cystinuria) often present multiple times to the emergency department—and all the repeated CT scans they might have would pack up a lot of radiation, indeed. The trial itself was well received for having very pragmatic and clinically relevant outcomes, with some relative minor concerns about generalizability (over exclusion of men > 129 kg and women > 113 kg). Much of the discussion also revolved around the fact that ~40% of the participants who were randomized to have an ultrasound did end up receiving a CT scan, and there was a lot of curiosity around what clinical factors may have triggered the CT (which was not presented in this paper) since it may help understand the nuances of the results better. Another practical consideration was around the difficulty of actually applying these results to real life practice, where it may not always be possible to get radiology to do an ultrasound or to have an ER MD well versed and trained to do one. With regards to the latter point, it was recognized that most of the younger emergency physicians are indeed now trained in doing ultrasounds—and it is even considered a part of a good physical examination. Lastly, should this one study change clinical practice, when the guidelines still suggest CT scans? The primary author (who tweeted briefly during the #uroJC discussion) does think that this paper may help change the consensus:
Overall, #NephJC is still running strong after about 6 months and promises to be another useful educational medium for individuals interested in the kidneys.
Post by Dr. Swapnil Hiremath, NephJC co-founder and eAJKD Contributor.