Öner Bozan, Yavuz Onur Danacıoğlu, Mehmet Muzaffer İslam

Acil servis doktorlarının akut renal kolikli hastaya yaklaşımı

Amaç: Çalışmamızda acil servise başvuran ve akut renal kolik tanısı alan hastalarda acil tıp uzmanı ve asistanların tanı ve tedavi stratejilerini belirlemeyi amaçladık.Gereç ve Yöntemler: Bu çalışmada acil tıp doktorlarına internet tabanlı kesitsel bir anket yapıldı. Ankette katılımcılara ait demografik verileri, acil serviste çalışma süreleri ve acil tıp uzmanı veya asistanı oldukları soruldu. Katılımcılara acil servise başvuran akut renal kolik hastalarında ilk tercih görüntüleme yöntemleri, tetkikler, hangi durumlarda üroloji konsültasyonu istedikleri, analjezik ve tedavi tercihleri soruldu. Bulgular: Çalışmaya katılan 108 gönüllünün yaş ortancası 31 (27 – 34,8) yıl olarak hesaplandı. Katılımcıların %60,2’i (n=65) acil tıp asistanı, %39,8’i (n=43) acil tıp uzmanı olan çalışma grubunun acil serviste çalıştığı sürenin yıl cinsinden ortancası 4 (2-8) yıl olarak hesaplandı. Acil tıp uzmanı ve asistanlarının renal kolik ön tanısı ile acil servise başvuran hastalardaki yaklaşımları ile ilgili değişkenler açısından farkları incelendi. Non-steroidal antienflamatuvar ilaç (NSAID) verilmesi planlanan hastalarda seçilecek ilk ilaç, diklofenak ve diğer NSAID olarak dikotomize edildiğinde, uzmanların 34 (%79,1)’nün, asistanların ise 60 (%92,3)’ının ilk tercih olarak diklofenak seçtiği görülmüş ve gruplar arasında istatistiksel anlamlı fark saptandı.Sonuç: Çalışmamızda acil tıp uzmanı ve asistanı arasında renal kolik görüntüleme yöntemi açısından benzer tercihler yapmasına rağmen birinci basamak tedavide acil tıp asistanları, acil tıp uzmanlarına kıyasla daha çok Diklofenak’ı tercih etmiştir.

Anahtar Kelimeler:

akut renal kolik, acil servis, böbrek taşı

The approach of emergency physicians to patients with acute renal colic

Objective: This study was conducted to describe the current diagnosis and treatment strategies of patients admitted to the emergency department and diagnosed with acute renal colic.Material and Methods: In this study, an internet-based cross-sectional survey was administered to emergency medicine physicians. In addition to the participants’ demographic data, such as age and gender, years of experience in the emergency medicine department, and whether they were a specialist or resident, the survey also inquired about their choices of imaging methods, laboratory tests, analgesic medications, and intravenous fluids, and tendency to refer patients to a urologist for a consultation.Results: The median age of the 108 volunteers participating in the study was calculated as 31 (27 - 34.8) years and their years of experience as 4 (2-8) years. More than half (60.2%, n=65) of the participants were emergency medicine residents, while the remaining 39.8% (n=43) were emergency medicine specialists. The emergency medicine specialists and residents were compared in terms of the variables related to their approaches to patients presenting to the emergency department with a preliminary diagnosis of renal colic. The first choice of analgesic drugs was dichotomised as diclofenac and other non-steroidal anti-inflammatory drugs, with 34 (79.1%) of the specialists and 60 (92.3%) of the residents reporting diclofenac as their first choice, and there was a statistically significant difference between the two groups.Conclusion: In this study, the emergency medicine residents preferred diclofenac more than the emergency medicine specialists in primary care, although they had similar renal colic imaging methods preferences.

Keywords:

acute renal colic, emergency department, kidney stone,

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Brown, J. Diagnostic and Treatment Patterns for Renal Colic in US Emergency Departments. Int Urol Nephrol 38, 87–92 (2006). 10.1007/s11255-005-3622-6
Phillips E, Kieley S, Johnson EB, et al. Emergency room management of ureteral calculi: current practices. Journal of endourology. 2009;23(6):1021-4. 10.1089/end.2008.0615
Ay MO, Avci A, Acehan S, et al. (2014). Acil Serviste Renal Kolikli Hasta Yönetimi . Arşiv Kaynak Tarama Dergisi , 23 (2) , 1-17 . 10.17827/aktd.66024
Corbo J, Wang J. Kidney and ureteral stones. Emerg Med Clin North Am. 2019;37(4):637-648. https://doi.org/10.1016/j.emc.2019.07.004
Aydin ME, Tekin E, Ahiskalioglu EO, et al. Erector spinae plane block vs non‐steroidal anti‐inflammatory drugs for severe renal colic pain: A pilot clinical feasibility study. Int J Clin Pract 2021;75(3):e13789. https://doi.org/10.1111/ijcp.13789
Cotta BH, Nguyen V, Sur RL, et al. Opiates prescribed for acute renal colic are associated with prolonged use. World J Urol. 2021;39(6):2183-2189. https://doi.org/10.1107/s00345-020-03386-7
Eysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Journal of medical Internet research. 2004;6(3):e132. 10.2196/jmir.6.3.e34
Leveridge M, D’Arcy FT, O’Kane D, et al. Renal colic: current protocols for emergency presentations. European Journal of Emergency Medicine. 2016;23(1):2-7. 10.1097/MEJ.0000000000000374
Minhaj FS, Hoang-Nguyen M, Tenney A, et al. Evaluation of opioid requirements in the management of renal colic after guideline implementation in the emergency department. Am J Emerg Med. 2020;38(12):2564-2569. https://doi.org/10.1016/j.ajem.2019.12.042
Alabousi A, Patlas MN, Mellnick VM, et al. Renal colic imaging: myths, recent trends, and controversies. Canadian Association of Radiologists' Journal. 2019;70(2):164-71. 10.1016/j.carj.2018.09.008
Türk C, Petřík A, Sarica K, et al. EAU guidelines on diagnosis and conservative management of urolithiasis. European urology. 2016;69(3):468-74. 10.1016/j.eururo.2015.07.040
Smith-Bindman R, Aubin C, Bailitz J, et al. Ultrasonography versus computed tomography for suspected nephrolithiasis. New England Journal of Medicine. 2014;371(12):1100-10. 10.1056/NEJMoa1404446
Pathan SA, Mitra B, Cameron PA. A systematic review and meta-analysis comparing the efficacy of nonsteroidal anti-inflammatory drugs, opioids, and paracetamol in the treatment of acute renal colic. European urology. 2018;73(4):583-95. 10.1016/j.eururo.2017.11.001
Holdgate A, Pollock T. Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic. Bmj. 2004;328(7453):1401. 10.1136/bmj.38119.581991.55
Afshar K, Jafari S, Marks AJ, Eftekhari A, MacNeily AE. Nonsteroidal anti‐inflammatory drugs (NSAIDs) and non‐opioids for acute renal colic. Cochrane Database of Systematic Reviews. 2015(6). 10.1002/14651858.CD006027.pub2
Angulo JC, Gaspar MJ, Rodríguez N, García-Tello A, Torres G, Núñez C. The value of C-reactive protein determination in patients with renal colic to decide urgent urinary diversion. Urology. 2010;76(2):301-6. 10.1016/j.urology.2009.12.002
McSorley S, Drury M, Majumdar P, Halsall A, Nalagatla S. C-reactive protein to predict the need for surgical intervention in acute renal colic. Journal of Clinical Urology. 2014;7(6):380-3. 10.1177/2051415813495679