ROLE OF THE PLAIN RADIOGRAPH AND URINALYSIS IN ACUTE URETERAL COLIC

Objective-(1) To determine the accuracy of accident and emergency (A&E ) doctors' diagnosis of radio-opaque ureteric calculi on plain abdomin al radiographs; (2) to study the predictive value of haematuria with a history suggestive of ureteric colic. Design-A prospective study of a ll patients seen in a three month period with a provisional diagnosis of ureteric colic. Intravenous urography (IVU) was used as the gold st andard for diagnosis of ureteric calculi. Setting-The accident and eme rgency department and medical unit of a large teaching hospital. Subje cts-60 patients who were admitted with an initial diagnosis of ureteri c colic, 51 subsequently undergoing intravenous urography. Results-A&E doctors achieved a calculated sensitivity of 29% (95% confidence inte rvals 13% to 49%) and a specificity of 73% (52% to 90%) for identifica tion of renal calculi on plain abdominal radiograph, compared with fig ures of 68% (48% to 84%) and 96% (78% to 100%) respectively for consul tant radiologists. The difference between these results was highly sig nificant (P = 0.0011). No patient with a definitive diagnosis of urete ric colic had a negative result for haematuria on urinary dipstick ana lysis. Conclusions-A&E doctors are poor at identifying radio-opaque ur eteric calculi on plain abdominal radiographs. If haematuria is absent on urinalysis then ureteric colic is an unlikely diagnosis.