Forget the blood, not the stone! Microhaematuria in acute urolithiasis and the role of early CT scanning

Xafis, K; Thalmann, G; Benneker, L M; Stoupis, C; Buggy, D J; Zimmermann, H; Exadaktylos, A K (2008). Forget the blood, not the stone! Microhaematuria in acute urolithiasis and the role of early CT scanning. Emergency medicine journal, 25(10), pp. 640-4. London: BMJ Publishing Group 10.1136/emj.2006.043703

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BACKGROUND: Although urinalysis is simple and inexpensive to perform, the finding of microhaematuria on urinalysis may be unreliable for diagnosing urolithiasis. OBJECTIVE: To evaluate microhaematuria as a diagnostic marker for urolithiasis compared with low-dose unenhanced multidetector computed tomography (MDCT) as the "gold standard". SETTING: A level 1 emergency department in a tertiary referral university teaching hospital. DESIGN: Retrospective analysis. METHODS: A study was undertaken to assess whether the finding of microhaematuria was diagnostic for urolithiasis using a low-dose unenhanced MDCT-based diagnosis as the reference standard by reviewing the records of all patients who presented to the emergency department with colicky flank pain and underwent a CT scan between January 2003 and December 2005. RESULTS: Urolithiasis was present (as defined by low-dose unenhanced MDCT) in 507/638 patients (79%); 341/638 (53%) were true positive for urolithiasis, 76 (12%) were true negative, 55 (9%) were false positive and 166 (26%) were false negative. Microhaematuria as a test for urolithiasis in patients presenting to the emergency department therefore has a sensitivity, specificity, positive predictive value and negative predictive value of 67%, 58%, 86% and 31%, respectively. 58% of the urinalysis results were negative for haematuria in the subset of patients with significant alternative diagnoses. CONCLUSIONS: The sensitivity, specificity and negative predictive value of microhaematuria on urinalysis for urolithiasis using unenhanced MDCT as the reference standard were low. This suggests that, when urolithiasis is clinically suspected, unenhanced MDCT is indicated without urinalysis being a prerequisite.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery 04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > University Emergency Center
UniBE Contributor:	Benneker, Lorin Michael, Zimmermann, Heinz (B), Exadaktylos, Aristomenis
ISSN:	1472-0205
ISBN:	18843059
Publisher:	BMJ Publishing Group
Language:	English
Submitter:	Factscience Import
Date Deposited:	04 Oct 2013 15:03
Last Modified:	29 Mar 2023 23:33
Publisher DOI:	10.1136/emj.2006.043703
PubMed ID:	18843059
Web of Science ID:	000259899000005
URI:	https://boris.unibe.ch/id/eprint/27437 (FactScience: 107501)