Larkin S, Johnson J, Venkatesh T, et al. - Researchers examined SIRS (systemic inflammatory response syndrome) as a risk factor for urgent renal drainage and revisit to the emergency department (ED) in patients with acute stone colic during their ED visit. They conducted a retrospective review of patients presenting to a tertiary academic ED from an obstructing ureteral or UPJ stone with hydronephrosis confirmed on an abdominal and pelvic CT scan. This study was carried out to analyze data over a 3-year period including stone size, presence of UTI, presence or absence of SIRS and other clinical variables as risk factors for urgent renal drainage and ED revisits. The study found, at the ED, 1,983 patients with urolithiasis and 649 patients had obstructive urolithiasis on CT scan. In obstructive urolithiasis patients, the presence of SIRS was an independent risk factor of acute urologic intervention and revisits to the ED. For obstructive stone patients, timely consultation with a urologist the following discharge from ED with SIRS who had no acute renal drainage may prevent revisit to the ED. Assessment for SIRS in addition to other clinical risk factors should be recognized while making management decisions in patients with acute stone obstruction.