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Efficacy of a fast-track pathway for managing uncomplicated renal or ureteral colic in a hospital emergency department: the STONE randomized clinical trial of Sonography and Testing of a Nephrolithiasis Episode




Tung Chen Y, Rodr√≠guez Fuertes P, Oliver S√°ez P, Vill√©n Villegas T, Bu√Īo Soto A, Fern√°ndez Calle P, Carballo Cardona C, Cobo Mora J, Ja√©n Ca√Īadas M, Yan Tong H, Borobia AM



Servicio de Urgencias, Hospital Universitario La Paz, Madrid, Spain. Departmento de Medicina, Universidad Alfonso X El Sabio, Madrid, Spain. Servicio de Análisis Clínicos, Hospital Universitario La Paz, Madrid, Spain. Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, Spain. Servicio de Urgencias, Hospital Universitario Ramón y Cajal, Madrid, Spain. Unidad Central de Investigación Clínica y Ensayos Clínicos (UCICEC), Servicio de Farmacología Clínica, Hospital Universitario La Paz, Madrid, Spain. IdiPAZ.



Objectives. To evaluate a fast-track pathway utilizing point-of-care (POC) testing and sonography as soon as uncomplicated renal or ureteral colic is suspected and to compare the POC clinical pathway to a standard one.
Methods. Unblinded randomized controlled clinical trial in a hospital emergency department (ED). We enrolled patients with suspected uncomplicated renal or ureteral colic and randomized them to a POC or standard pathway (1:1 ratio). Duration of ED stay, treatments, the proportion of diagnoses other than uncomplicated colic, and 30-day
complications were analyzed.
Results. One hundred forty patients were recruited between November 2018 and October 2019; data for 124 were analyzed. The mean (SD) total time in the ED was 112 (45) minutes in the POC arm and 244 (102) in the standard arm (P < .001). Treatments, alternative diagnoses, and complication rates did not differ.
Conclusion. The use of a fast-track POC pathway to manage uncomplicated colic in the ED is effective and safe. It also reduces the amount of time spent in the ED.


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