AB021. SOH26AB_0044. The evaluation of compliance with iRefer guidelines for the investigation of acute renal colic

Background: Computed tomography of the kidneys, ureters, and bladder (CTKUB) is the first-line investigation for an acute renal colic presentation in the non-pregnant adult population, as per the iRefer Royal College of Radiologists (RCR) guidance. This study aimed to evaluate compliance with iRefer guidelines.

Methods: A retrospective report was run through the National Integrated Medical Imaging System (NIMIS) to collect data on every CTKUB performed in Wexford General Hospital (WGH) from January 2023 to January 2025. The NIMIS database was reviewed to assess the indication for each scan, whether an X-ray abdomen (XRA) was performed prior, the result of the XRA and CTKUB, and the average time gap between the XRA and CTKUB being performed.

Results: Sample size included 485 patients. Of these patients, 67.2% of these had an XRA within 1 week prior to the computed tomography (CT) being performed. Of these, the indication for 93.3% was to investigate acute renal colic, and the remaining 6.7% had a different indication. Only 32.8% of patients adhered to national guidelines, and of those patients, only 35.2% did so due to clinical suspicion alone; the remainder either had a known history of urolithiasis or had another radiological investigation done prior. The average time between scans, given that an XRA was performed, was 1.28 days.

Conclusions: The first-line investigation for acute renal colic was not in keeping with national guidelines. The use of XRAs subjects patients to unnecessary additional radiation exposure and delays to treatment since they do not affect further clinical decision making. Further review of the radiology guidelines is required in WGH.

Keywords: Abdomen; emergency; radiology; renal colic; urology