Can resident-performed POCUS and clinical predictors effectively risk-stratify emergency department patients with confirmed renal colic?

Authors

Mohannad Alghamdi, Dunya Alfaraj, Laila Buarish, Maram Busuhail, Abdulrazzag Alharbi, Khaled Alharthi, Abdullah Alotaibi, Talal Albogami, Abdulaziz Alsaleh, Arwaa Haji, Thamir AlSayed

Published in

International journal of emergency medicine. Jul 06, 2026. Epub Jul 06, 2026.

Abstract

Universal reliance on non-contrast computed tomography (NCCT KUB) for suspected renal colic contributes to emergency department (ED) overcrowding and significant radiation exposure. This study evaluates the diagnostic performance of resident-performed point-of-care ultrasound (POCUS) alongside clinical and laboratory markers to establish an early multi-modal risk-stratification framework for managing patients with confirmed urolithiasis.
We conducted a retrospective observational cohort study of 313 consecutive patients with CT-confirmed urolithiasis at a tertiary-care ED over six months. We assessed the diagnostic performance of resident-performed POCUS for hydronephrosis detection against CT as the reference standard, and used multivariable logistic regression to identify independent clinical predictors of CT-confirmed hydronephrosis.
Documented resident-performed POCUS achieved a high sensitivity of 91.1% for identifying hydronephrosis against CT imaging, but displayed a critically low specificity of 21.4%. Microscopic hematuria operated at an extremely high baseline prevalence of 84.4% (n = 255 of 302 patients with urinalysis) across the cohort. Multivariable logistic regression identified three independent predictors of CT-confirmed hydronephrosis: microscopic hematuria (OR = 3.91, 95% CI [1.85, 8.23], p <.001), nausea or vomiting (OR = 3.29, 95% CI [1.27, 8.56], p =.015), and female sex (OR = 0.34, 95% CI [0.17, 0.68], p =.002). Resident-performed POCUS achieved a PPV of 89.3% alongside its high sensitivity, reinforcing its utility as a rule-in adjunct. A secondary bivariate analysis linked elevated serum creatinine (> 1.4 mg/dL) to acute inpatient resource utilization (p <.001).
While resident-performed POCUS is a sensitive but poorly specific tool for detecting hydronephrosis, it cannot safely guide disposition in isolation. Its clinical value lies in integration: when combined with key clinical red flags and secondary biochemical markers, it enables a structured, multi-modal approach to risk stratification that is practical and radiation-sparing in a high-volume emergency setting. Prospective multicenter trials are needed to validate this framework in pre-imaging triage settings.

PMID:
42410334
Bibliographic data and abstract were imported from PubMed on 07 Jul 2026.

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