Utility Of Point of Care Ultrasound in Patients with suspected renal colic presenting to Emergency Medicine Department: KEYSTONE study

**Title:**Utilityof Point of Care Ultrasound in patients with suspected renal colic presentingto Emergency Medicine Department KEYSTONE study.

Our objective is to determine the sensitivity and specificity of Point ofcare ultrasound performed by Emergency physicians for detectinghydroureteronephrosis in patients with suspected renal colic. We would also like to validate KEYSTONE protocol in detecting key emergentdifferential diagnosis such as aortic aneurysm, appendicitis in patients with suspected renal colic. Renal colic is one of the mostcommon presentations in the Emergency Medicine Department. It is important torule out emergent differential diagnoses like abdominal aortic aneurysm,ectopic pregnancy, acute appendicitis lower lobe pneumonia, gall bladderpathologies etc. in such patients. We propose that point of care ultrasound doneby Emergency Physician can quickly rule out hydroureteronephrosis and otherdifferential diagnosis and accelerate disposition in such patients. This willhelp to triage patients who require urgent further imaging modalities andinterventions and other resource allocations. This will also help to improvethe ED turn-around time for these patients. Point of careultrasound is bedside ,routinely done standard of care test in emergencydepartment to detect, life threating emergencies early. In our study point ofcare ultrasound is done to detect hydroureteronephrosis in patients withsuspected renal colic (loin to groin pain ) and also to pick up otherdifferentials as mentioned below .and to compare sensitivity and specificity ofpoint of care ultrasound in picking of this emergencies with the standardradiological investigations like USG/CT scan. Point of care ultrasound isbedside routinely done examination no extra charges /cost is added to thepatients.

**Description of study process:**This is a prospective observational study to be conductedin the Emergency Medicine Department of Kasturba medical college and Hospital,Manipal. Patients with suspected renal colic who fulfil inclusioncriteria will be enrolled into the study after taking informed consent. Pointof care ultrasound as per the KEYSTONE Protocol will be performed by trainedemergency physicians who are accredited by the local PCPNDT regulatory body. After focused history and check listed clinical examination,point of care ultrasound protocol (KEYSTONE protocol) will be carried out inpatients with renal colic. It includes a formatted checklist of differentialdiagnosis, which will be assessed sequentially:  (Titled as KEYSTONE protocol)

1.    Kidney: Presence hydroureteronephrosiswith grading and other pertinent findings

2.    Abdominal aorta:Aneurysmal dilatation/ dissection

3.    Appendix:Enlargement/ collection.

4.    Free fluid inabdomen and pelvis.

5.    Gall bladderpathologies – Cholelithiasis, cholecystitis

6.    Lower lobe pneumonia.

The findings will be noted in the preassigned datacollection form

The treatment of the patient will be simultaneouslycarried out without interruption or delay. As per the existing protocol of thedepartment, the patient will undergo pertinent radiological imaging (ultrasoundby radiologist or CT scan) as per treating physician’s discretion. The POCUSfindings will not be shared with the radiologist. The findings in the furtherimaging will be noted for comparison. Also, Individual advice regarding followup of case will be recorded. A 30-day telephonic follow-up, along with review ofmedical records of patient, if done in the same institution, will be done. Thepurpose is to note for passage of stone by the participants and any urologicalintervention or repeat hospital, repeat Emergency Medicine Department visits,admissions, OPD follow-up in the 1 month. The sensitivity and specificity of point of careultrasound performed by emergency physicians for detectinghydroureteronephrosis in patients with suspected renal colic. The correlation of the results of the KEYSTONE protocolswith the radiological and clinical findings and outcomes including follow upfindings will be done.