The diagnostic value of computed tomography in the management of patients with acute flank pain: An observational cohort study.

Abstract

Introduction: The need for immediate CT in patients with acute flank pain is debated. We aimed to study the diagnostic value and therapeutic impact of CT in these patients. Furthermore, to identify factors associated with intervention and determine who would benefit from acute imaging.

Material and methods: A retrospective review was performed of patients with acute flank pain admitted to the emergency department at Haukeland University Hospital between June 2023-June 2024. In total, 289 patients with 319 referrals were included in the study.

Results: A total of 142 women and 147 men, with a median age of 48 years (IQR 35-60) were registered. Acute CT was performed in 197 cases (62%), and a cause for flank pain was determined in 159 (81%). A ureteral stone was detected in 122 (62%). Acute ureteroscopy was performed in 48 (39%) of these, while 27 (22%) were drained with a JJ-stent or nephrostomy tube only. Irrespective of the cause for acute flank pain, 234 patients (73%) received conservative treatment only. Patients needing intervention had higher levels of CRP (52 vs 15 mg/L, p < 0.001) and creatinine (108 vs 87 μmol/L, p < 0.001) compared to those treated conservatively. 219 patients (69%) had CT at follow-up after 3-4 weeks. A persistent ureteral stone needing ureteroscopy was registered in 40 (19%).

Conclusion: CT in patients with acute flank pain may be reserved for complicated cases with signs of infection, elevated CRP and creatinine levels. In uncomplicated cases, CT can safely be deferred until follow-up after 3-4 weeks.