Written by Chris Thom
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In this multicenter prospective study, POCUS findings were combined into a novel ECOLIC score to identify patients at low risk for urological intervention.
Using POCUS to determine who needs urologic intervention
This was a multicenter study of adult patients with suspected renal colic at 3 Emergency Departments in France. The primary outcome was urgent urological care within 30 days. Twenty-five potential predictor variables were evaluated.
176 patients were enrolled, with 25 (15%) needing urgent urological intervention. Three independent predictor variables for the primary outcome were identified; POCUS findings of moderate or severe hydronephrosis (OR 5.9, 95%CI 2.5-15.4), pain persistence at 4 hours (OR 12.1, 95%CI 4.5-35.1), and age (OR 1.0, 95%CI 1.0-1).
The ECOLIC score was then derived as the following:
- age > 65 years (1 point),
- moderate to severe hydronephrosis on POCUS (2 points),
- and persistent pain at 4 hours (3 points).
An ECOLIC score < 1 demonstrated a 98% negative predictive value for urgent urological intervention.
How will this change my practice?
POCUS has been shown to have similar patient outcomes to CT in cases of suspected renal colic. However, the use of these imaging modalities on specific patients remains debated. There is also significant variability between ED physicians and CT versus POCUS utilization. One of the resources I think is particularly helpful is the study published in both Annals of EM and JACR, which goes through specific patient scenarios and provides imaging testing recommendations. From the current study, we see that patients younger than 65 with minimal hydronephrosis on POCUS and no persistent pain were unlikely to require urgent urologic intervention, identifying a population in whom CT imaging may be safely avoided.
POCUS pro tips and clips
The kidneys are generally easy to image, but the left kidney is tucked a bit more posterior than the right. You usually get the best image of the left kidney by having the probe posteriorly positioned and almost to the stretcher surface. It can also help to have the patient take an inspiratory breath hold, which can push the kidney inferior and out of the way of the ribs. Moderate and severe hydronephrosis are easy to spot. Mild hydronephrosis is more subtle, and that’s where experience and pattern recognition help greatly. Comparing the contralateral kidney can also help determine true mild hydronephrosis versus normal.
Source
Point-of-care ultrasound for risk stratification of urgent urological care in acute uncomplicated renal colic. CJEM. 2025 Dec;27(12):984-994. doi: 10.1007/s43678-025-01008-y. Epub 2025 Oct 25. PMID: 41138020.
View JournalFeed Critical Appraisal
Critical Appraisal
Study Identification
Background
Study Question
Study Design & Conduct
Prospective / Retrospective: Prospective
Multicenter: Yes
Unit of Allocation: Not applicable
Unit of Analysis: Patients
Randomization Method: Not applicable
Allocation Concealment: Not applicable
Blinding: Not applicable
Follow-up Duration: 30 days
Population
- Adult patients with suspected uncomplicated acute renal colic
- Renal colic considered most probable diagnosis by treating physician
- Suspicion of urinary tract infection
- Hemodynamic instability
- Single kidney
- Renal transplantation
- Pregnancy
- Age below 18 years
- Lack of consent
Number Enrolled: 168
Number Analyzed: 168
Key Baseline Characteristics
Sex: 49% female
Disease Severity: Not reported
Care Setting Distribution: Emergency Department
Additional Baseline Characteristics
- 45% with history of renal colic
Exposures / Interventions
Description: POCUS examination
Definition / Dose: Assessment of hydronephrosis severity
Timing: Upon ED presentation
Classification Method: Performed by trained emergency physicians
Protocolized / Discretionary: Protocolized
Description: Not applicable
Definition: Not applicable
Outcomes & Results
Primary Outcomes
Definition: In-hospital admission, urological procedure within 24 hours after ED admission, or new ED admission within 30 days leading to urgent urological procedure within 24 hours.
Time Point: 30 days
Measurement Method: Medical record review and follow-up calls
Results: 15% required urgent urological care
Secondary Outcomes
Definition: Rate of alternative diagnoses identified
Time Point: During ED visit
Measurement Method: POCUS examination
Results: Not reported
Risk of Bias
Risk of Bias - ROBINS-I
- Confounding (Low): Study controlled for major confounders through multivariable analysis.
- Selection of Participants (Low): Consecutive patients were included, reducing selection bias.
- Classification of Interventions (Low): Interventions were clearly defined and consistently applied.
- Deviations from Intended Interventions (Low): Interventions were protocolized and deviations were unlikely.
- Missing Data (Low): No missing data reported for primary outcomes.
- Measurement of Outcomes (Low): Outcomes were clearly defined and measured consistently.
- Selection of the Reported Result (Low): All relevant outcomes were reported.
Transparency
COI Statement Present: TRUE
