Title: Utility of Point of Care Ultrasound in patients with suspected renal colic presenting to Emergency Medicine Department KEYSTONE study.

Our objective is to determine the sensitivity and specificity of Point of care ultrasound performed by Emergency physicians for detecting hydroureteronephrosis in patients with suspected renal colic. We would also like to validate KEYSTONE protocol in detecting key emergent differential diagnosis such as aortic aneurysm, appendicitis in patients with suspected renal colic. Renal colic is one of the most common presentations in the Emergency Medicine Department. It is important to rule out emergent differential diagnoses like abdominal aortic aneurysm, ectopic pregnancy, acute appendicitis lower lobe pneumonia, gall bladder pathologies etc. in such patients. We propose that point of care ultrasound done by Emergency Physician can quickly rule out hydroureteronephrosis and other differential diagnosis and accelerate disposition in such patients. This will help to triage patients who require urgent further imaging modalities and interventions and other resource allocations. This will also help to improve the ED turn-around time for these patients. Point of care ultrasound is bedside ,routinely done standard of care test in emergency department to detect, life threating emergencies early. In our study point of care ultrasound is done to detect hydroureteronephrosis in patients with suspected renal colic (loin to groin pain ) and also to pick up other differentials as mentioned below .and to compare sensitivity and specificity of point of care ultrasound in picking of this emergencies with the standard radiological investigations like USG/CT scan. Point of care ultrasound is bedside routinely done examination no extra charges /cost is added to the patients.  

Description of study process: This is a prospective observational study to be conducted in the Emergency Medicine Department of Kasturba medical college and Hospital, Manipal. Patients with suspected renal colic who fulfil inclusion criteria will be enrolled into the study after taking informed consent. Point of care ultrasound as per the KEYSTONE Protocol will be performed by trained emergency physicians who are accredited by the local PCPNDT regulatory body. After focused history and check listed clinical examination, point of care ultrasound protocol (KEYSTONE protocol) will be carried out in patients with renal colic. It includes a formatted checklist of differential diagnosis, which will be assessed sequentially:  (Titled as KEYSTONE protocol)

1.     Kidney: Presence hydroureteronephrosis with grading and other pertinent findings

2.     Abdominal aorta: Aneurysmal dilatation/ dissection

3.     Appendix: Enlargement/ collection.

4.     Free fluid in abdomen and pelvis.

5.     Gall bladder pathologies – Cholelithiasis, cholecystitis

6.     Lower lobe pneumonia.

The findings will be noted in the preassigned data collection form

The treatment of the patient will be simultaneously carried out without interruption or delay. As per the existing protocol of the department, the patient will undergo pertinent radiological imaging (ultrasound by radiologist or CT scan) as per treating physician’s discretion. The POCUS findings will not be shared with the radiologist. The findings in the further imaging will be noted for comparison. Also, Individual advice regarding follow up of case will be recorded. A 30-day telephonic follow-up, along with review of medical records of patient, if done in the same institution, will be done. The purpose is to note for passage of stone by the participants and any urological intervention or repeat hospital, repeat Emergency Medicine Department visits, admissions, OPD follow-up in the 1 month. The sensitivity and specificity of point of care ultrasound performed by emergency physicians for detecting hydroureteronephrosis in patients with suspected renal colic. The correlation of the results of the KEYSTONE protocols with the radiological and clinical findings and outcomes including follow up findings will be done.