Melinda McPherson
Journal of Paramedic Practice, Vol. 8, Iss. 2, 04 Feb 2016, pp 80 - 85

Renal colic is a common pre-hospital presentation that is often conveyed to
hospital due to diagnostic uncertainty. The use of the STONE score and a greater
understanding of computerised tomography (CT) requirement in the diagnostic
process can aid the pre-hospital clinician in making an informed decision about
the management of these patients.
Case: A 48-year-old female presenting with symptoms of renal colic who was
assessed, managed and treated at home.
Methods: A literature search was carried out on Medline, Cinahl, BNI and Embase.
In addition, searches of the NHS evidence database (www.evidence.nhs.uk) and the
Cochrane Database of Systematic Reviews (www.cochrane.org) were completed.
Results: The search yielded 536 results, each of which were browsed for
relevance, duplicates removed and their references reviewed. 16 articles
were relevant to the use of CT to diagnose renal calculi and four addressed
the derivation and validation of the STONE score. These were critically
reviewed and conclusions drawn about their applicability to the pre-hospital
environment.
Conclusions: The STONE score, when combined with clinical judgement and
if applied to the right patient group, is an appropriate clinical decision tool to
identify uncomplicated renal calculi. CT imaging of this low-risk patient group is
not required to confirm diagnosis; however, delayed CT scanning is required to
form a management plan.

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