Does pain severity predict stone characteristics or outcomes in emergency department patients with acute renal colic?

OBJECTIVES: After initial emergency department (ED) management of acute renal colic, recurrent or ongoing severe pain is the usual pathway to ED revisits, hospitalizations and rescue interventions. If index visit pain severity is associated with stone size or with subsequent failure of conservative management, then it might be useful in identifying patients who would benefit from early definitive imaging or intervention. Our objectives were to determine whether pain severity correlates with stone size, and to evaluate its utility in predicting important outcomes. METHODS: We used administrative data and structured chart review to study all ED patients with CT proven renal colic at six hospitals in two cities over one-year. Triage nurses recorded arrival numeric rating scale (NRS) pain scores. We excluded patients with missing pain assessments and stratified eligible patients into severe (NRS 8-10) and less-severe pain groups. Stone parameters were abstracted from imaging reports, while hospitalizations and interventions were identified in hospital databases. We determined the classification accuracy of pain severity for stones >5mm and used multivariable regression to determine the association of pain severity with 60-day treatment failure, defined by hospitalization or rescue intervention. RESULTS: We studied 2206 patients, 68% male, with a mean age of 49 years. Severe pain was 52.0% sensitive and 45.3% specific for larger stones >5mm. After multivariable adjustment, we found a weak negative association (adjusted OR =0.96) between pain severity and stone width. For each unit of increasing pain, the odds of a larger stone fell by 4%. Index visit pain severity was not associated with the need for hospitalization or rescue intervention within 60-days. CONCLUSIONS: Pain severity is not helpful in predicting stone size or renal colic outcomes. More severe pain does not indicate a larger stone or a worse prognosis.

Increasing the mobility of EEG data collection using a Latte Panda computer.

BACKGROUND: Electroencephalography (EEG) experiments often require several computers to ensure accurate stimulus presentation and data collection. However, this requirement can make it more difficult to perform such experiments in mobile settings within, or outside, the laboratory. NEW METHOD: Computer miniaturisation and increasing processing power allow for EEG experiments to become more portable. Our goal is to show that a Latte Panda, a small Windows 10 computer, can be used to accurately collect EEG data in a similar manner to a laptop. Using a stationary bike, we also suggest that the Latte Panda will allow for more portable EEG experiments. RESULTS: Significant and reliable MMN and P3 responses, event-related potentials (ERPs) typically associated with auditory oddball tasks, were observed and were consistent when using either the laptop or Latte Panda for EEG data collection. Similar MMN and P3 ERPs were also measured in the sitting and stationary biking conditions while using a Latte Panda for data collection. COMPARISON WITH EXISTING METHOD: Data recorded by the Latte Panda computer produced comparable and equally reliable results to the laptop. As well, similar ERPs during sitting and biking would suggest that EEG experiments can be conducted in more mobile situations despite the increased noise and artifacts associated with muscle movement. CONCLUSIONS: Our results show that the Latte Panda is a low-cost, more portable alternative to a laptop computer for recording EEG data. Such a device will further allow for more portable and mobile EEG experimentation in a wider variety of environments.