Accuracy of computed tomography of the kidneys, ureters and bladder interpretation by emergency physicians

Authors

  • Momtaz Rafi,

    1. Emergency Department, Nepean Hospital, Sydney, New South Wales, Australia
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  • Amith Shetty,

    1. Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia
    2. Discipline of Emergency Medicine, Sydney Medical School, Sydney, New South Wales, Australia
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  • Naren Gunja

    Corresponding author
    1. Discipline of Emergency Medicine, Sydney Medical School, Sydney, New South Wales, Australia
    • Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia
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  • Momtaz Rafi, FACEM, Emergency Physician; Amith Shetty, FACEM, Emergency Physician, Clinical Senior Lecturer; Naren Gunja, MSc, FACEM, FACMT, Emergency Physician and Toxicologist, Clinical Associate Professor.

Correspondence: Associate Professor Naren Gunja, Emergency Department, Westmead Hospital, Sydney, NSW 2145, Australia. Email: naren.gunja@sydney.edu.au

Abstract

Objective

The study aims to determine the interpretation accuracy of computed tomography of the kidneys, ureters and bladder (CT-KUB) by emergency physicians (EPs) compared with the formal radiology report, as the reference standard, in patients with suspected acute urinary tract calculous disease.

Methods

A sample of 20 consecutive CT-KUB scans for suspected acute calculous disease was compiled from the medical imaging department of an adult tertiary teaching hospital. Ten EPs with a minimum of 2 years' experience post-Fellowship interpreted each scan using a template form. The total sample of 200 reports by EPs was compared with the formal radiology report for agreement in detecting renal tract stones, signs of obstruction and other clinical findings. Interrater agreement and the kappa statistic were used for comparative data analysis.

Results

There was a high level of agreement (%, kappa value) between EPs and radiologists for the detection of large (≥5 mm) calculi (94.5%, κ 0.89), signs of obstruction (93%, κ 0.86) and clinically significant findings (90%, κ 0.78). The level of agreement was low for the detection of small (<5 mm) calculi (79%, κ 0.48) and clinically non-significant findings (67.5%, κ 0.33).

Conclusion

EPs can accurately detect clinically significant acute calculous disease and signs of obstruction on CT-KUB, allowing for ongoing acute management and early disposition of the patient. However, their findings should be verified against the formal radiology report when available.

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