M. Eskelinen et al., Usefulness of history-taking, physical examination and diagnostic scoring in acute renal colic, EUR UROL, 34(6), 1998, pp. 467-473
Objective: The accuracy of the clinical diagnosis of acute renal colic was
studied in connection with the survey of acute abdominal pain by the Resear
ch Committee of the World Organization of Gastroenterology. The diagnostic
efficiency of various clinical symptoms, signs and tests have not previousl
y been analyzed in the diagnosis of acute renal colic, and therefore the st
udy is of potential importance. Methods: 1,333 patients presenting with acu
te abdominal pain were included in the study. The clinical findings in each
patient were recorded in detail, using a predefined structured data collec
tion sheet, and the collected data were compared with the final diagnoses o
f the patients. Twenty-three clinical history variables, 14 clinical signs
and 3 tests were evaluated in a single variable and multivariate analysis.
Results: In multivariate logistic regression analysis, the most significant
predictors of acute renal colic were urine, tenderness, renal tenderness,
duration of pain and appetite. The sensitivity in detecting acute renal col
ic was 0.84, with a specificity of 0.99 and an efficiency of 0.98. To sum u
p the contributions of most significant diagnostic factors, a diagnostic sc
ore (DS) was built. This score incorporated independent variables, e.g. uri
ne, tenderness, renal tenderness, duration of pain, appetite and sex. The D
S reached a sensitivity of 0.89 in detecting acute renal colic, with a spec
ificity of 0.99 and an efficiency of 0.99. Conclusions: The results clearly
show that acute abdominal pain with normal appetite, short duration of pai
n (less than or equal to 12 h), loin or renal tenderness and hematuria (ery
throcytes >10) are indicative of acute renal colic, and therefore, in this
particular clinical question, careful history-taking and physical examinati
on are of utmost importance. In our study, the DS system performed well con
sidering the simple nature of its structure. However, to minimize the risk
to the patient, we recommend that the DS is used only as an aid in decision
-making when there is uncertainty as to the diagnosis of acute renal colic
and the need for immediate treatment. In addition, the possibility of obstr
uctive pyelonephritis in combination with renal colic should be considered
clinically.