ABSTRACT
Background Urinary stone disease is a common reason for emergency department (ED) visits, and a computed tomography scan of the kidneys, ureters, and bladder (CT-KUB) is frequently used for diagnosis. The objective of this study was to estimate the positive rate of CT-KUB and identify predictors of emergency interventions for patients with ureteric stones. Methods A retrospective study was conducted to investigate the positive rate of CT-KUB for urinary stone disease and to explore the factors that determine the need for emergency urologic interventions. The study population included adult patients who underwent CT-KUB to rule out urinary stones at King Fahd University Hospital. Results The study included 364 patients, of whom 245 (67.3%) were men and 119 (32.7%) were women. CT-KUB revealed stones in 243 (66.8%) patients, including 32.4% with renal stones and 54.4% with ureteric stones. Female patients were more likely to have normal results than male patients. Approximately 26.8% of patients with ureteric stones required emergency urologic intervention. Multivariable analysis found that the size and location of ureteric stones were independent predictors for emergency intervention. Patients with distal ureteric stones were 35% less likely to need emergency interventions than those with proximal stones. Conclusion The positive rate of CT-KUB was acceptable for patients with suspected urinary stone disease. Most demographic and clinical characteristics were not predictors for emergency interventions, but the size and location of ureteric stones and elevated creatinine levels were significantly associated.
ABSTRACT
BACKGROUND: Coagulopathy is a well-recognized complication in patients with coronavirus disease 2019 (COVID-19). Pulmonary embolism (PE) has substantial morbidity and mortality if the diagnosis is missed or the management is delayed. Computed tomography pulmonary angiography (CT-PA) is the imaging modality of choice for PE. Therefore, this study aimed to investigate the positive rate of CT-PA for PE among patients with COVID-19. METHODS: We conducted a retrospective study examining the diagnostic yield of CT-PA in patients with confirmed COVID-19 and compared it with that in patients without COVID-19. The study included all adult patients with confirmed COVID-19 who presented from June 2020 to June 2021. RESULTS: The study included 316 patients, including 158 patients with COVID-19, who underwent CT-PA for ruling out PE. Overall, 76 patients were found to have PE on the CT-PA scan, yielding a positive rate of 24.1%, with a significant difference between patients with COVID-19 (8.2%) and those without COVID-19 (39.9%). Further, 138 (87.3%) patients with COVID-19 had elevated D-dimer levels compared with 34 (21.5%) patients without COVID-19. A multivariable regression analysis model revealed that the smoking status (odds ratio [OR] = 1.94; 95% confidence interval [CI]: 1.4-3.8) and obesity (OR = 4.1; 95% CI: 1.5-8.9) were independent predictors of PE among patients with COVID-19. However, the elevated D-dimer level was not significantly associated with PE among patients with COVID-19 (OR = 0.7; 95% CI: 0.4-1.8). CONCLUSION: The study found that the positive rate of CT-PA for PE was lower among patients with PE indicating probable overutilization of investigation in these patients. Additionally, patients with COVID-19 had a higher proportion of elevated D-dimer levels that may be a contributor to the increased investigation for PE. Lastly, patients with COVID-19 who were current smokers had a higher tendency of having PE.
