Clinical Accuracy of Renal Colic Diagnosis before Imaging; Are we Biased?

Author(s): Caleb Jing Hua Loo, Pourya Pouryahya

Introduction: Renal Colic is a common presentation to the Emergency Department (ED), accounting for 1.05 % of ED presentations. The aim of the study is to determine the accuracy of triage system in patients presenting with suspected renal colic and the effect of labelling bias in this cohort.

Methods: This was a retrospective cross-sectional study of adults (above 18 years old) presenting to any of the three Monash Health EDs between March 2019 and June 2019 and triaged as suspected renal colic. 43180 patients over 18 years old presented to Monash Health EDs during the study period, of which 275 were includ- ed in the study (0.64%).

Results: In 603 (1.40%) patients, the diagnosis of renal colic was confirmed. We calculated the triage accuracy of ED triage system for renal colic to be 78.8%. 371 (61.5%) were not identified as suspected renal colic at triage. Renal colic was confirmed in 234 (38.5%) patients upon discharge from ED. The other 41 (14.9) had been diagnosed with other alterative diagnosis. Comparing patients who were diagnosed with renal colic and other alternative diagnosis, the median ages of the 2 sub-groups were similar, however, the group with not renal colic diagnosis on discharge, had a larger proportion of females. A Chi Square test was performed which showed a statistically significant difference among the 2 groups in terms of gender (P=0.000124331).

Conclusions: Triage system for suspected renal colic seems to have a good accuracy. However, ED physicians should consider labelling bias and other differential diagnoses when assessing female patients with flank pain or tenderness, as there is a higher chance of misdiagnosis.

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