Some patients with acute renal colic can be managed as outpatients, while others should be admitted to the hospital. Wright et al offer criteria to help identify patients suitable for each option. The authors are from the University of Durham in England.
Factors affecting decision:
(1) support at home and ability to receive health care in an emergency
(2) conditions in the differential diagnosis
(3) if female, possibility of pregnancy
Parameters:
(1) spontaneous resolution or response to analgesics
(2) social support
(3) ability to access emergency medical care
(4) risk of ectopic pregnancy (in women)
(5) risk of leaking abdominal aortic aneurysm (in elderly)
(6) personal preference
(7) history of single functioning kidney
(8) pregnancy (in women)
(9) presence of other significant clinical findings
|
Parameter |
Finding |
Outpatient |
Inpatient |
|
pain |
subsides spontaneously |
1 |
0 |
|
|
subsides after administration of analgesic |
1 |
0 |
|
|
unrelieved by analgesic |
0 |
1 |
|
social support at home |
adequate |
1 |
0 |
|
|
inadequate |
0 |
1 |
|
contact by phone |
possible |
1 |
0 |
|
|
impossible |
0 |
1 |
|
patient preference |
stay at home |
1 |
0 |
|
|
management in hospital |
0 |
1 |
|
age |
< 60 years of age |
1 |
0 |
|
|
>= 60 years of age (due to chance of leaking abdominal aortic aneurysm) |
0 |
1 |
|
female |
not of reproductive age |
1 |
0 |
|
|
reproductive age with possible ectopic pregnancy |
0 |
1 |
|
|
pregnant |
0 |
1 |
|
number of functioning kidneys |
2 |
1 |
0 |
|
|
0 or 1 |
0 |
1 |
|
other significant clinical findings |
none |
1 |
0 |
|
|
fever and evidence of infection |
0 |
1 |
|
|
anuria |
0 |
1 |
|
|
systemic illness |
0 |
1 |
number of indications to treat as inpatient =
= SUM(inpatient parameter points)
number of indications to treat as outpatient =
= SUM(outpatient parameter points)
The default action is to admit if there are any indications for management as an inpatient.
Specialty: Nephrology, Clinical Laboratory
ICD-10: ,
