Emergency computed tomography in acute renal colic is essential for correct diagnosis and shortens time to treatment and stone-free status.

Introduction: This study aimed to evaluate the clinical impact of implementing routine emergency computed tomography (eCT) for all patients presenting with suspected acute renal colic at the emergency department (ED). Material and methods: We did a retrospective observational study of all patients who underwent eCT for suspected acute renal colic at the ED in Helsingborg between May 9, 2023 and May 8, 2024 and compared with a 2019/2020 cohort not using routine eCT. Results: Of 66,540 ED visits during the study period, 1,566 patients underwent eCT for suspected acute renal colic; 1,261 were included in the analysis after exclusions. In 57% of patients, no symptomatic stone was identified; nevertheless, one fifth required hospital admission for alternative diagnoses. A radiologically proven stone explaining their symptoms was found in 43% of patients. Compared with the 2019/2020 cohort, the 2023/2024 cohort had more treatments (33% vs 21%), and significantly shorter time to both treatment (p = 0.01) and clinical closure (p <0.001). Stone size, location, type of treatment and number of visits to the ED were comparable between the two cohorts. Conclusions: Acute renal colic in its clinical presentation appeared to be less diagnostically reliable than previously assumed. The use of eCT ensured accurate diagnosis of urolithiasis, significantly shortened time to treatment, and to a stone-free patient as well as reduced the use of stents. We propose that eCT should be implemented as a routine procedure in the management of acute renal colic.