EFFECTIVENESS OF BEDSİDE EMERGENCY ULTRASONOGRAPHY IN PATIENTS WITH RENAL COLIC PRESENTING TO THE EMERGENCY DEPARTMENT

Abstract

Objective: This study aimed to evaluate the diagnostic performance of point-of-care ultrasound (POCUS) for detecting and grading hydronephrosis in patients presenting to the emergency department (ED) with suspected renal colic, using non-contrast computed tomography (CT) as the reference standard. Material and Methods: This prospective observational diagnostic accuracy study included 106 adult patients who underwent both renal POCUS and non-contrast CT during the same ED visit. Hydronephrosis was classified as none, mild, moderate, or severe. The diagnostic performance of POCUS was assessed for detecting any hydronephrosis (grade ≥2) and moderate-to-severe hydronephrosis (grade ≥3). Agreement between POCUS and CT grading was evaluated using kappa coefficients.Results: CT demonstrated hydronephrosis in 58 patients (54.7%). For any hydronephrosis, POCUS showed a sensitivity of 86.2%, specificity of 83.3%, and overall accuracy of 84.9% (κ=0.695; p<0.001). Exact agreement across the four grades was 62.3%, while within-one-grade agreement was 98.1%. Linear-weighted and quadratic-weighted κ values were 0.626 and 0.777, respectively. POCUS assigned a higher grade than CT in 30 cases and a lower grade in 10 cases (p=0.001). For moderate-to-severe hydronephrosis, sensitivity was 88.9%, specificity was 82.3%, and negative predictive value was 95.6%.Conclusion: POCUS provides good diagnostic performance for the rapid, radiation-free assessment of hydronephrosis in renal colic. However, because it tends to overestimate hydronephrosis severity compared with CT, high-grade POCUS findings should not be considered directly equivalent to the corresponding CT grade.