Table.

Summary of the consensus group's findings

Aspect of care	Consensus reached	Consensus recommendation	Level of evidence	Grade of recommendation
Timing of assessment	Yes	Patients with acute symptoms should receive a medical assessment within 30 minutes	3/4	D
Establishing a diagnosis	Yes	Diagnosis is centred on abrupt onset of severe unilateral flank pain radiating into the groin or genitals	3/4	D
Atypical cases	Yes	Over 60 years of age: consider a leaking abdominal aortic aneurysm; women with delayed menses: consider ectopic pregnancy	2++	B
Assessment of pain	No	Use of visual analogue scale considered helpful, but view among general practitioners was that they would prefer to judge severity themselves	4	D
Urinalysis for blood on site	No	General agreement that haematuria supports the diagnosis, but urinalysis considered impractical by those preferring to rely on clinical judgment, and often patients are unable to void on demand	2++	C
Examination	Yes	Assessment must include examination of abdomen and exclude signs consistent with other conditions (for example, peritonitis). Assessment of vital signs (pulse, blood pressure, and temperature) to exclude signs of shock and systemic infection	2−	C/D
Treatment	Yes	After assessment, analgesia should be given to provide rapid pain relief (within half an hour). Consensus favoured giving diclofenac given by intramuscular injection	1−	A
Failure of analgesia	Yes	Failure of analgesia after 1 hour: immediately admit patient to hospital (by phone) without further consultation	4	D
Recurrent pain	No	Some general practitioners in favour of issuing limited supplies of oral or rectal analgesia with instruction for self administration	4	D
Follow up	Yes	General practitioner to initiate follow up by phone 1 hour after initial assessment	4	D
Investigation	Yes	Investigate all patients with suspected acute renal colic to identify the calculus and determine management	4	D
Advice to patient	Yes	Maintain higher fluid intake and attempt to sieve urine	4	D
Written information	Yes	Issuing written information by general practitioners for patients considered impractical in the acute setting	4	D
Fast track investigation	Yes	All in favour of fast track general practitioner access for renal imaging within 7 days of onset and urology outpatients within 14 days of onset (if a calculus is identified), plus immediately sending results to general practitioner	4	D
Workload	No	Some participants anticipated an increase in workload for radiologists and general practitioners
Pilot study	Yes	All in favour of a pilot or feasibility study to evaluate fast track path of care for patients with suspected acute renal colic
Hospital admissions	Yes	Anticipated reduction in number of urgent hospital admissions for suspected acute renal colic resulting from fast track path for renal imaging combined with urology review