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Inicio Actas Urológicas Españolas (English Edition) Impact of a delayed presentation to the emergency department for acute renal col...
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Vol. 47. Issue 1.
Pages 41-46 (January - February 2023)
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Vol. 47. Issue 1.
Pages 41-46 (January - February 2023)
Original article
Impact of a delayed presentation to the emergency department for acute renal colic on biochemical and clinical outcomes
Impacto de la presentación tardía al servicio de urgencias por cólico renal agudo en los resultados bioquímicos y clínicos
G. Manticaa,b, D.M. Carrionb,c, M. Antón-Juanillad, K.H. Pangb,e, S. Parodia, S. Tapperoa, A. Rodriguez-Serranoc, V. Crespo-Atínd, R. Cansinoc, R.M. Scarpaf, S. Niklesb,g, F. Balzarinia,
Corresponding author
balzarini.federica90@gmail.com

Corresponding author.
, C. Terronea, J. Gomez Rivasb,h, F. Espertob,f
a Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
b European Society of Residents in Urology (ESRU), Arnhem, The Netherlands
c Department of Urology, La Paz University Hospital, Madrid, Autonomous University of Madrid, Madrid, Spain
d Department of Urology, Cruces University Hospital, Barakaldo, Vizcaya, Spain
e Department of Oncology and Metabolism, Academic Urology Unit, University of Sheffield, Sheffield, UK
f Department of Urology, Campus Biomedico, University of Rome, Italy
g Department of Urology, Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia
h Department of Urology, Hospital Clinico San Carlos, Madrid, Spain
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Tables (2)
Table 1. Comparison of clinical and biochemical parameters between patients presenting to ED within or after 24 h onset of symptoms.
Table 2. Comparison of management between Group A and Group B.
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Abstract
Introduction and Objective

To verify the impact of delay on biochemical and clinical outcomes for patients presenting to the emergency department (ED) with acute renal colic.

Materials and Methods

Data were retrospectively collected from three institutions of two European countries between 01 January and 30 April 2020. Patients who presented to the ED with unilateral or bilateral renal colic caused by urolithiasis confirmed by imaging tests during the study period were included. A presentation after 24 h since the onset of symptoms was considered a delay. Patients presenting before 24 h from the symptom onset were included in Group A, while the patients presenting after 24 h in Group B. Clinical and biochemical parameters and management were compared.

Results

A total of 397 patients who presented to ED with confirmed urolithiasis were analyzed (Group A, n = 199; Group B, n = 198. The median (IQR) delay in presentation was 2 days (1,5-4). At presentation, no statistically significant differences were found amongst the two groups of patients regarding presenting symptoms such as fever and flank pain, and the median serum levels of creatinine, C reactive protein and white blood cells. No differences were found in terms of conservative or operative management.

Conclusion

Delay in consultation >24 h is not associated with worsening biochemical parameters and clinical outcomes. Most patients with acute loin pain do not necessarily need urgent attendance to the ED and may be managed in the outpatients

Keywords:
Emergency department
Acute renal colic
Impact of delay
Biochemical and clinical outcomes
Resumen
Introducción y objetivo

Verificar el impacto en los resultados bioquímicos y clínicos de la demora en acudir al servicio de urgencias (SU) ante un cólico renal agudo.

Materiales y métodos

Los datos se recogieron retrospectivamente en tres instituciones de dos países europeos, desde el 1 de enero hasta el 30 de abril de 2020. Se incluyeron los pacientes que acudieron a urgencias con un cólico renal unilateral o bilateral causado por urolitiasis confirmada por imagen durante el periodo de estudio. La consulta en el SU después de 24 horas desde el inicio de los síntomas se consideró tardía. Los pacientes que acudieron antes de las 24 horas desde el inicio de los síntomas se incluyeron en el grupo A, y los pacientes que se presentaron después de las 24 horas se adjudicaron al grupo B. Se compararon los parámetros clínicos y bioquímicos, así como el manejo recibido por cada paciente.

Resultados

Se analizaron 397 pacientes que acudieron a urgencias con urolitiasis confirmada (Grupo A, n = 199; Grupo B, n = 198. La mediana (RIC) de demora hasta la consulta fue de 2 días (1,5-4). En el momento de la consulta, no se encontraron diferencias estadísticamente significativas entre los dos grupos de pacientes en cuanto a los síntomas como fiebre y dolor en el flanco, o la mediana de los niveles séricos de creatinina, proteína C reactiva y leucocitos. No se encontraron diferencias en cuanto al tratamiento conservador o quirúrgico.

Conclusiones

La demora >24 horas hasta acudir al SU no se asocia a un empeoramiento de los parámetros bioquímicos ni de los resultados clínicos. La mayoría de los pacientes con dolor lumbar agudo no siempre necesitan acudir de forma inmediata a urgencias, pudiendo ser tratados en consultas externas.

Palabras clave:
Servicio de urgencias
Cólico renal agudo
Impacto de la demora en acudir
Resultados bioquímicos y clínicos

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