Shared Decision-Making for the Promotion of Patient-Centered Imaging in the ED: Suspected Kidney Stones
Shared Decision-Making for the Promotion of Patient-Centered Imaging in the ED: Suspected Kidney Stones
Although a CT scan is required for some Emergency Department patients with signs and symptoms
 of a kidney stone, recent evidence has shown that routine scanning is unnecessary and may
 expose young patients to significant cumulative radiation, increasing their risk of future
 cancers. Shared Decision-Making may facilitate diagnostic imaging decisions that are more
 inline with patients' values and preferences. By comparing a shared approach to diagnostic
 decision-making to a traditional, physician-directed approach, this study lays the foundation
 for a future randomized trial that will reduce radiation exposure, improve engagement, and
 improve the quality and patient-centeredness of Emergency Department care.
Inclusion Criteria:

 1. Age 18-55,

 2. with acute flank pain - for whom clinician believes acute flank pain may be from renal
 colic

 3. who are deemed by the treating clinician to be at low risk for dangerous alternative
 diagnoses.

 4. Clinician is considering imaging patient for kidney stones (any imaging)

 Exclusion Criteria:

 1. Recent trauma related to pain (including minor such as lifting/turning)

 2. Pregnancy (previous or discovered during ED visit)

 3. Recent surgical procedure on abdomen or pelvis (30d)

 4. Recent urologic procedure (30d)

 5. Recent childbirth (30d)

 6. Signs of Systemic Infection: Fever >100.9 (101 and up), SBP <90, HR>120

 7. Moderate or severe abdominal tenderness or rebound/guarding, consistently present
 (present for more than one exam, or present after patient treated with pain
 medication)

 8. Second doctor's visit (ED, PCP, urgent care) for THIS episode of pain (previous
 similar visits ok if pain gone for >30d in between episodes) (if seen at PCP or urgent
 care in same day or 24 hour period, this is not an exclusion, but if seen at
 PCP/urgent care or ED 1-30 days prior to index visit, with same pain, excluded)

 9. Known history of one kidney or other urological/renal abnormality (including
 neurogenic bladder, ESRD and paraplegia; or if solitary kidney discovered on US)

 10. Known malignancy (any) within past year (or received treatment in the past 12 months)

 11. Immunocompromised (chronic steroids, HIV, crohns, immunomodulators or severely ill
 chronically)

 12. On anticoagulation

 13. Crisis patient (behavioral health)/belligerent

 14. Lacks capacity for medical decision-making

 15. Unlikely to respond to follow-up calls (IVDA, homeless, no phone)

 16. Clinician is concerned for alternative diagnosis requiring CT scan (appendicitis) (>5%
 likelihood by clinician gestalt)

 17. Patient is not improving clinically and clinician is considering admission