Association of Time-to-“Association of STONE Score Calculation To Reduced CT Scan Usage in the Emergency Department: A Systematic Review
Keywords:
STONE score, computed tomography, emergency department, renal colic, utilization reduction, clinical decision rule, ultrasound-firstAbstract
Introduction: The increasing use of computed tomography (CT) in emergency departments (EDs) for suspected renal colic raises concerns about radiation exposure and healthcare costs. The STONE clinical prediction score was developed to stratify patients by risk of urolithiasis, potentially guiding more judicious imaging. This systematic review aims to synthesize evidence on the association between STONE score implementation and CT scan utilization reduction in the ED.
Methods: A systematic review was conducted following a structured screening protocol. Studies were included if they were conducted in an ED setting, involved adult patients with suspected kidney stones, implemented or evaluated the STONE score, and reported CT utilization outcomes. Data were extracted on study design, STONE score implementation, CT usage metrics, clinical outcomes, and implementation barriers.
Results: Of 80 screened sources, only four studies directly examined STONE score implementation. The score demonstrated high heterogeneity in performance across studies but was useful for risk stratification (low-risk: ~12% stone prevalence; high-risk: ~83%). Direct evidence linking STONE score use to reduced CT ordering is scant. One prospective study showed STONE-guided reduced-dose CT protocols achieved 88.2% radiation dose reduction while maintaining high sensitivity. Broader evidence supports alternative strategies for CT reduction, including ultrasound-first protocols (achieving 7.7% absolute reduction) and low-dose CT protocols (75-88% dose reduction). Multispecialty consensus suggests 45% of clinical scenarios may require no imaging.
Discussion: The STONE score’s primary utility appears to be identifying low-risk patients who may avoid imaging, rather than reducing overall CT ordering. Successful CT reduction requires multifaceted interventions beyond prediction tools, including ultrasound-first pathways, low-dose protocols, and system-level changes like interdisciplinary collaboration and workflow integration. Significant barriers persist, including clinician comfort, radiologist acceptance of reduced-dose CT, and a gap between evidence and practice.
Conclusion: While the STONE score is a valid risk-stratification tool, direct evidence of its effectiveness in reducing CT scan utilization is limited. Its value is likely as part of a comprehensive, multi-strategy approach that includes ultrasound-first algorithms and dose optimization protocols. Future implementation research should focus on integrating the STONE score into clinical decision support systems within broader diagnostic pathways.
References
A. Meltzer, J. Hollander, A. B. Wolfson, M. Kurz, S. Jackman, Z. Kirkali, J. Kusek, and P. K. Burrows. “RANDOMIZED CLINICAL TRIAL OF TREATMENT WITH TAMSULOSIN BEGUN IN THE EMERGENCY DEPARTMENT TO PROMOTE PASSAGE OF URINARY STONES: PNFLBA‐04,” 2017.
A. Shemesh, Ben Shalom, Eyal Hen, Eyal Barkai, F. Atamna, Haitham Abu Nijmeh, A. Cooper, and O. Raz. “[UROLOGICAL CONSULT FOR PATIENT WITH RENAL COLIC BEFORE DISCHARGE FROM THE EMERGENCY DEPARTMENT (ED): THE OUTCOME EFFECT ON SPONTANEOUS STONE EXPULSION AND RE-VISIT TO ED].” Harefuah, 2022.
Alan Shan, G. Baumann, and A. Gholamrezanezhad. “Patient Race/Ethnicity and Diagnostic Imaging Utilization in the Emergency Department: A Systematic Review.” Journal of the American College of Radiology, 2020.
B. H. Chi, I. H. Chang, Dong Hoon Lee, S. B. Park, Kyung Do Kim, Y. Moon, and T. Hur. “Low-Dose Unenhanced Computed Tomography with Iterative Reconstruction for Diagnosis of Ureter Stones.” Yonsei Medical Journal, 2018.
B. Tombal, H. Mawlawi, A. Feyaerts, F. Wese, R. Opsomer, and P. V. Van Cangh. “Prospective Randomized Evaluation of Emergency Extracorporeal Shock Wave Lithotripsy (ESWL) on the Short-Time Outcome of Symptomatic Ureteral Stones.” European Urology, 2005.
C. Dunne, Jason L. Elzinga, A. Vorobeichik, Sanjana Sudershan, D. Keto‐Lambert, E. Lang, and S. Dowling. “A Systematic Review of Interventions to Reduce Computed Tomography Usage in the Emergency Department.” Annals of Emergency Medicine, 2022.
C. Moore, B. Daniels, D. Singh, S. Luty, G. Gunabushanam, M. Ghita, A. Molinaro, and C. Gross. “Ureteral Stones: Implementation of a Reduced-Dose CT Protocol in Patients in the Emergency Department with Moderate to High Likelihood of Calculi on the Basis of STONE Score.” Radiology, 2016.
C. Moore, B. Daniels, M. Ghita, G. Gunabushanam, S. Luty, A. Molinaro, D. Singh, and C. Gross. “Accuracy of Reduced-Dose Computed Tomography for Ureteral Stones in Emergency Department Patients.” Annals of Emergency Medicine, 2015.
C. Moore, C. Carpenter, M. Heilbrun, K. Klauer, A. Krambeck, C. Moreno, E. Remer, C. Scales, Melissa M. Shaw, and Kevan M. Sternberg. “Imaging in Suspected Renal Colic: Systematic Review of the Literature and Multispecialty Consensus.” Journal of the American College of Radiology, 2019.
———. “Imaging in Suspected Renal Colic: Systematic Review of the Literature and Multispecialty Consensus.” Annals of Emergency Medicine, 2019.
C. Moore, C. Carpenter, Marta Heilbrun, K. Klauer, A. Krambeck, C. Moreno, E. Remer, C. Scales, Melissa M. Shaw, and Kevan M. Sternberg. “Imaging in Suspected Renal Colic: Systematic Review of the Literature and Multispecialty Consensus.” Journal of Urology, 2019.
C. Moore, M. Bhargavan-Chatfield, Melissa M. Shaw, K. Weisenthal, and M. Kalra. “Radiation Dose Reduction in Kidney Stone CT: A Randomized, Facility-Based Intervention.” Journal of the American College of Radiology, 2021.
C. Wiysonge. “Immunotherapy for Tuberculous Pericarditis.” New England Journal of Medicine, 2014.
C. Wong, P. Young, M. Ross, H. Robertson, and E. Lang. “LO82: The Accuracy and Prognostic Value of Point-of-Care Ultrasound for Renal Colic: A Systematic Review,” 2017.
Charles K. H. Wong, Braden D. Teitge, M. Ross, P. Young, H. Robertson, and E. Lang. “The Accuracy and Prognostic Value of Point‐of‐care Ultrasound for Nephrolithiasis in the Emergency Department: A Systematic Review and Meta‐analysis.” Academic Emergency Medicine, 2018.
Chen-Chih huang, Y. Wong, Li-Jen Wang, T. Chiu, C. Ng, and Jih-Chang Chen. “Decreased Renal Parenchymal Density on Unenhanced Helical Computed Tomography for Diagnosis of Ureteral Stone Disease in Emergent Patients with Acute Flank Pain.” Chang Gung Medical Journal, 2008.
D. Assimos, A. Krambeck, Nicole Miller, M. Monga, M. H. Murad, C. Nelson, K. Pace, et al. “Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART I.” Journal of Urology, 2016.
Dima Raskolnikov, M. K. Hall, S. Ngo, M. Dighe, Joel A. Gross, J. Harper, and J. Gore. “MP83-15 PROSPECTIVE EVALUATION OF A NEPHROLITHIASIS EMERGENCY DEPARTMENT DISCHARGE PATHWAY,” 2020.
E. Schoenfeld, K. Poronsky, L. Westafer, Brianna M. DiFronzo, P. Visintainer, C. Scales, E. Hess, and P. Lindenauer. “Feasibility and Efficacy of a Decision Aid for Emergency Department Patients with Suspected Ureterolithiasis: Protocol for an Adaptive Randomized Controlled Trial.” Trials, 2021.
Esra Akçiçek, Ahmet Gürkan Erdemir, İlkay Sedakat İdilman, Mehmet Ruhi Onur, E. Akpınar, and B. Erbil. “The Problem-Solving Role of the ’Wait and Repeat CT’ Approach in the Diagnosis and Treatment of Acute Abdomen.” Ulusal Travma Ve Acil Cerrahi Dergisi-Turkish Journal of Trauma & Emergency Surgery, 2025.
F. Rodger, G. Roditi, and O. Aboumarzouk. “Diagnostic Accuracy of Low and Ultra-Low Dose CT for Identification of Urinary Tract Stones: A Systematic Review.” Urologia Internationalis, 2018.
G. Innes, J. Teichman, F. Scheuermeyer, A. McRae, E. Grafstein, J. Andruchow, Lucy Cheng, and M. Law. “Does Early Intervention Improve Outcomes for Patients with Acute Ureteral Colic?” Canadian Journal of Emergency Medicine, 2019.
H. Alkadhi, and Natalia Saltybaeva. “Lost Opportunities: Radiologists Are Not Sufficiently Using Reduced-Dose CT for Kidney Stones.” Radiology, 2018.
H. Mirfazaelian, A. Doosti-Irani, M. Jalili, and V. Thiruganasambandamoorthy. “Application of Decision Rules on Diagnosis and Prognosis of Renal Colic: A Systematic Review and Meta-Analysis.” European Journal of Emergency Medicine, 2020.
H. Xiang, M. Chan, V. Brown, Y. Huo, L. Chan, and L. Ridley. “Systematic Review and Meta‐analysis of the Diagnostic Accuracy of Low‐dose Computed Tomography of the Kidneys, Ureters and Bladder for Urolithiasis.” Journal of Medical Imaging and Radiation Oncology, 2017.
Hasan Yeşilağaç, İ. Arer, B. Gulalp, H. Yabanoğlu, Ozlem Karagun, and E. Karadeli. “ADVANCED JOURNAL OF EMERGENCY MEDICINE. 2020;4(2):e21,” 2020.
I. Metzler, R. Smith-Bindman, M. Moghadassi, Ralph C. Wang, M. Stoller, and T. Chi. “Emergency Department Imaging Modality Effect on Surgical Management of Nephrolithiasis: A Multicenter, Randomized Clinical Trial.” Journal of Urology, 2017.
Ian Berger, Alexandria A Spellman, Vishnukamal Golla, Michael E Lipkin, G. Faerber, Jodi Antonelli, Charles D. Scales, and Deborah R Kaye. “MP16-02 WORK PRODUCTIVITY OF PATIENTS UNDERGOING TRIAL OF PASSAGE FOR URETERAL STONES.” Journal of Urology, 2023.
J. Melnikow, G. Xing, G. Cox, P. Leigh, L. Mills, D. Miglioretti, M. Moghadassi, and R. Smith-Bindman. “Cost Analysis of the STONE Randomized Trial: Can Health Care Costs Be Reduced One Test at a Time?” Medical Care, 2016.
Jason L. Elzinga, C. Dunne, A. Vorobeichik, D. Keto‐Lambert, D. Grigat, E. Lang, and S. Dowling. “A Systematic Review Protocol to Determine the Most Effective Strategies to Reduce Computed Tomography Usage in the Emergency Department.” Cureus, 2020.
Jennifer L Portis, Suzanne M Neises, and A. Portis. “Pain Is Independent of Stone Burden and Predicts Surgical Intervention in Patients with Ureteral Stones.” Journal of Urology, 2018.
Jesse Spooner, Kaveh Masoumi-Ravandi, Wyatt MacNevin, G. Ilie, Thomas Skinner, and Andrea Lantz Powers. “Septic and Febrile Kidney Stone Presentations During the COVID-19 Pandemic: What Is the Effect of Reduced Access to Care During Pandemic Restrictions?” Canadian Urological Association Journal = Journal de l'Association Des Urologues Du Canada, 2023.
Joseph Basile, J. Kenny, B. Khodorkovsky, E. Youssef, B. Ardolic, J. Chacko, and B. Hahn. “Effects of Eliminating Routine Use of Oral Contrast for Computed Tomography of the Abdomen and Pelvis: A Pilot Study.” Clinical Imaging, 2018.
K. Lindqvist, M. Hellström, G. Holmberg, R. Peeker, and L. Grenabo. “Immediate Versus Deferred Radiological Investigation After Acute Renal Colic: A Prospective Randomized Study.” Scandinavian Journal of Urology and Nephrology, 2006.
K. Shah, and J. Guthrie. “Does Immediate Total-Body Computed Tomography Reduce Mortality and Time in the Emergency Department for Trauma Patients?” Annals of Emergency Medicine, 2014.
Kirsten Foell, M. Ordon, D. Ghiculete, Jason Y. Lee, R. Honey, and K. Pace. “Does Baseline Radiography of the Kidneys, Ureters, and Bladder Help Facilitate Stone Management in Patients Presenting to the Emergency Department with Renal Colic?” Journal of Endourology, 2013.
L. Tzelves, Panagiotis Angelopoulos, T. Markopoulos, Athanasios Papatsoris, I. Mitsogiannis, I. Varkarakis, and Andreas Skolarikos. “Imaging Follow-up for Stone Patients: A Randomized Trial Using Ultrasound.” Hellenic Urology, 2024.
M. Assmus, S. De, Trevor D Schuler, D. Bochinski, and T. Wollin. “The "Acute" Stone Clinic Effect: Improving Healthcare Delivery by Reorganizing Clinical Resources.” Journal of Endourology, 2017.
M. Gautam, A. Ullah, and M. Pathak. “Low Dose Computed Tomography in Diagnosis of Ureteric Calculus in Obese Patients,” 2020.
M. Gottlieb, D. Hill, and Kimbia Arno. “Is Point‐of‐Care Ultrasonography Effective for the Diagnosis of Urolithiasis?” Annals of Emergency Medicine, 2019.
M. Moran. “Towards Keeping the Hippocratic Oath (Six Sigma).” Urolithiasis, 2013.
M. Ordon, S. Bota, Y. Kang, and B. Welk. “MP16-03 THE IMPACT OF TIMING OF DEFINITIVE INTERVENTION FOR PATIENTS WITH ACUTE RENAL COLIC: A POPULATION-BASED STUDY.” Journal of Urology, 2023.
Mei-Yi Ong, Justin Koh, S. Kothan, and Christopher Lai. “The Incidence and Associated Risk Factors of Contrast-Induced Nephropathy After Contrast-Enhanced Computed Tomography in the Emergency Setting: A Systematic Review.” Life, 2022.
Monica Tung, Ritu Sharma, J. Hinson, Stephanie Nothelle, Jean Pannikottu, and J. Segal. “Factors Associated with Imaging Overuse in the Emergency Department: A Systematic Review.” American Journal of Emergency Medicine, 2017.
N. Kinnear, M. Herath, Dylan Barnett, D. Hennessey, C. Dobbins, T. Sammour, and James W. Moore. “A Systematic Review of Dedicated Models of Care for Emergency Urological Patients.” Asian Journal of Urology, 2020.
N. Shivakumar, Dhanya Nantha Kumar, and H. Joshi. “The Impact of Early COVID-19 Pandemic on the Presentation and Management of Urinary Calculi Across the Globe - A Systematic Review.” Journal of Endourology, 2022.
O. Claros, Carlos Hirokatsu Watanabe Silva, Horácio Consolmagno, A. Sakai, Rodrigo Freddy, and Oscar Eduardo Hidetoshi Fugita. “Current Practices in the Management of Patients with Ureteral Calculi in the Emergency Room of a University Hospital.” Clinics, 2012.
P. Dahm, A. Koziarz, C. Gerardo, D. Nishijima, J. Jung, S. Benipal, and A. Raja. “A Systematic Review and Meta‐analysis of Clinical Signs, Symptoms, and Imaging Findings in Patients with Suspected Renal Colic.” Journal of the American College of Emergency Physicians Open, 2022.
P. Dahm, A. Koziarz, C. Gerardo, S. Benipal, D. Nishijima, J. Jung, and A. Raja. “MP54-01 A SYSTEMATIC REVIEW OF CLINICAL SIGNS AND SYMPTOMS, PREDICTION RULES AND IMAGING MODALITIES IN PATIENTS WITH SUSPECTED RENAL COLIC,” 2021.
P. Massaro, A. Kanji, P. Atkinson, R. Pawsey, and T. Whelan. “Is Computed Tomography-Defined Obstruction a Predictor of Urological Intervention in Emergency Department Patients Presenting with Renal Colic?” Canadian Urological Association Journal = Journal de l'Association Des Urologues Du Canada, 2017.
P. Sen, E. Edison, and D. Smith. “191 The Effect of Covid-19 on the Management of Acute Ureteric Colic in a Tertiary Hospital.” British Journal of Surgery, 2022.
Prakashini Koteshwar, C. Kakkar, S. Sripathi, A. Parakh, and R. Shrivastav. “Low Dose MDCT with Tube Current Modulation: Role in Detection of Urolithiasis and Patient Effective Dose Reduction.” Journal of Clinical and Diagnostic Research : JCDR, 2016.
R. Gohil, R. Agha, T. Tang, and S. R. Walsh. “Early Cross‐sectional Imaging for Patients with Acute Abdominal Pain: Systematic Review of Randomised Clinical Trials.” International Journal of Clinical Practice. Supplement, 2011.
R. Radecki, and Rory J. Spiegel. “Laboring Under the Stone: Answers to the January 2015 Annals of Emergency Medicine Journal Club.” Annals of Emergency Medicine, 2015.
R. Sehgal, Y. Abu-Ghanem, C. Fontaine, L. Forster, R. Kucheria, D. Allen, A. Goyal, G. Ellis, Paras Singh, and L. Ajayi. “MP65-17 IS PRIMARY URETEROSCOPY MORE COST-EFFECTIVE THAN URETERAL STENTING FOR OBSTRUCTING URETERAL CALCULI?” 2021.
R. Smith-Bindman, C. Aubin, J. Bailitz, R. Bengiamin, Carlos A. Camargo, J. Corbo, A. J. Dean, et al. “Ultrasonography Versus Computed Tomography for Suspected Nephrolithiasis.” New England Journal of Medicine, 2014.
Rajesh Bhayana, Chenhan D Wang, R. Menezes, E. Bartlett, and Joseph Choi. “Optimising After-Hours Workflow of Computed Tomography Orders in the Emergency Department.” BMJ Open Quality, 2020.
Ralph C. Wang, J. Fahimi, David Dillon, William Shyy, John T Mongan, C. McCulloch, and R. Smith-Bindman. “Effect of an Ultrasound-First Clinical Decision Tool in Emergency Department Patients with Suspected Nephrolithiasis: A Randomized Trial.” American Journal of Emergency Medicine, 2022.
Ramin Haghighi, Jalal Rezaei, Fatemeh Khaleghi, Mohammad Hamidi Madani, Hussein Soleimantabar, Mahsa Norouzi, Mojtaba Karbalaee, Zahra Askari, Roozbeh Roohinezhad, and Rasoul Jafari Arismani. “Preferred Radiological Modalities in the Diagnosis and Management of Kidney and Urinary Tract Stones; a Systematic Review.” Journal of Renal Injury Prevention, 2025.
S. Guercio, A. Ambu, F. Mangione, M. Mari, F. Vacca, and M. Bellina. “Randomized Prospective Trial Comparing Immediate Versus Delayed Ureteroscopy for Patients with Ureteral Calculi and Normal Renal Function Who Present to the Emergency Department.” Journal of Endourology, 2011.
S. Kim, I. Jo, Taerim Kim, S. Hwang, J. Park, T. Shin, M. Sim, W. Cha, and Hee Yoon. “Usefulness of Protocolized Point-of-Care Ultrasonography for Patients with Acute Renal Colic Who Visited Emergency Department: A Randomized Controlled Study.” Medicina, 2019.
S. Kravchick, I. Bunkin, Eugeny Stepnov, R. Peled, L. Agulansky, and S. Cytron. “Emergency Extracorporeal Shockwave Lithotripsy for Acute Renal Colic Caused by Upper Urinary-Tract Stones.” Journal of Endourology, 2005.
S. Pendem. “Effectiveness of Low Dose Over Standard Dose CT for Detection of Urolithiasis: A Systematic Review.” Indian Journal of Forensic Medicine & Toxicology, 2020.
S. Tartari, R. Rizzati, R. Righi, A. Deledda, S. Terrani, and G. Benea. “Low-Dose Unenhanced CT Protocols According to Individual Body Size for Evaluating Suspected Renal Colic: Cumulative Radiation Exposures.” La Radiologia Medica, 2010.
S. Yallappa, T. Amer, Patrick Jones, F. Greco, T. Tailly, B. Somani, N. Umez-Eronini, and O. Aboumarzouk. “Natural History of Conservatively Managed Ureteral Stones: Analysis of 6600 Patients.” Journal of Endourology, 2018.
Suad S. Al-Bulushi MD, ABEM, Mahmood S.AL-Jufaili M.D.FRCPC, Naima N. Al-Henai M.D. ABEM, Ahmed S. Al-Abri M.D, and Spateeka P. Kalkunte M.D. “NORMAL ED ULTRASOUND PREDICTS LOW RISK RENAL COLIC PATIENTS FOR UROLOGICAL INTERVENTION WITHIN 90 DAYS.” EPH-International Journal of Medical and Health Science, 2015.
T. Begaz, D. Elashoff, T. Grogan, D. Talan, and B. Taira. “Initiating Diagnostic Studies on Patients With Abdominal Pain in the Waiting Room Decreases Time Spent in an Emergency Department Bed: A Randomized Controlled Trial.” Annals of Emergency Medicine, 2017.
T. Drake, Nitin Jain, T. Bryant, I. Wilson, and Bhaskar K. Somani. “Should Low-Dose Computed Tomography Kidneys, Ureter and Bladder Be the New Investigation of Choice in Suspected Renal Colic?: A Systematic Review.” Indian Journal of Urology, 2014.
T. Niemann, T. Kollmann, and G. Bongartz. “Diagnostic Performance of Low-Dose CT for the Detection of Urolithiasis: A Meta-Analysis.” AJR. American Journal of Roentgenology, 2008.
Tiina T. Lehtimäki, P. Juvonen, H. Valtonen, P. Miettinen, H. Paajanen, and R. Vanninen. “Impact of Routine Contrast-Enhanced CT on Costs and Use of Hospital Resources in Patients with Acute Abdomen. Results of a Randomised Clinical Trial.” European Radiology, 2013.
Tony T Chen, Chu Wang, Michael N. Ferrandino, C. Scales, T. Yoshizumi, G. Preminger, and M. Lipkin. “Radiation Exposure During the Evaluation and Management of Nephrolithiasis.” Journal of Urology, 2015.
Trevor A. McGrath, R. Frank, N. Schieda, B. Blew, J. Salameh, P. Bossuyt, and M. McInnes. “Diagnostic Accuracy of Dual-Energy Computed Tomography (DECT) to Differentiate Uric Acid from Non-Uric Acid Calculi: Systematic Review and Meta-Analysis.” European Radiology, 2020.
Victoria Valencia, M. Moghadassi, D. Kriesel, S. Cummings, and R. Smith-Bindman. “Study of Tomography Of Nephrolithiasis Evaluation (STONE): Methodology, Approach and Rationale.” Contemporary Clinical Trials, 2014.
W. F. Lee, S. J. Goh, Berlin Lee, S. J. Juan, Marxengel Asinas-Tan, and B. L. Lim. “Renal Point-of-Care Ultrasound Performed by ED Staff with Limited Training and 30-Day Outcomes in Patients with Renal Colic.” CJEM, 2024.
Xiao Wang, Ying Cao, Jing Hu, Liancheng Jia, Bo Li, Baoli Liu, Weihai Yao, et al. “Effect of Early-Intervention Acupuncture on Pain Relief Among Emergency Department Patients with Suspected Acute Renal Colic Due to Urinary Calculi: Study Protocol for a Randomized Clinical Trial.” Journal of Pain Research, 2024.
Y. Matani, Mohammed A Al-Ghazo, R. Al-azab, O. B. Hani, I. Ghalayini, and I. B. Hani. “Emergency Versus Elective Ureteroscopic Treatment of Ureteral Stones.” Canadian Urological Association Journal = Journal de l'Association Des Urologues Du Canada, 2013.
Y. Nuswantoro, and Efa Anggraini. “THE SYSTEMATIC REVIEW OF RADIOLOGIC IMAGING IN SUSPECTED RENAL COLIC.” Journal of Advanced Research in Medical and Health Science, 2024.
Y. Park, R. Jung, Young Geun Lee, C. K. Hong, J. Ahn, T. Shin, Young Sik Kim, and Y. Ha. “Does the Use of Bedside Ultrasonography Reduce Emergency Department Length of Stay for Patients with Renal Colic?: A Pilot Study.” Clinical and Experimental Emergency Medicine, 2016.
Y. Tung Chen, Pablo Rodríguez Fuertes, Paloma Oliver Sáez, Tomás Villén Villegas, A. Buño Soto, P. Fernández Calle, César Carballo Cardona, et al. “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.” Emergencias, 2021.
Zachary A Valley, and K. Kaler. “Acute Care for Renal Colic in Canadian Healthcare - a Commentary on Emergency Department Patient Flow Metrics and Treatment Options.” Canadian Urological Association Journal = Journal de l'Association Des Urologues Du Canada, 2020.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Raynaldo Adnan Dinarwanto, Mochamad Sri Herlambang (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors publishing here keep copyright but grant the journal first publication rights, under a Creative Commons Attribution-NonCommercial 4.0 License. They can distribute their work non-exclusively elsewhere with an acknowledgment of its first publication in this journal. Posting the work online before and during submission for earlier and greater citation is encouraged, reflecting Open Access benefits.
