A 72-year-old woman presents to the ED with a 2-hour history of sudden, severe lower back pain radiating into the lower abdomen. She looks pale and clammy and tells you “this feels different to anything I’ve had before.” She has a history of long-standing hypertension and smoked until age 60.

On arrival she is alert but visibly uncomfortable. Her capillary refill is slightly prolonged, her pulse feels thready, and her systolic blood pressure fluctuates around the low 90s without clear improvement after IV fluids. Examination reveals a tender lower abdomen with no peritonism.

Your SHO suggests that this may be renal colic given the colicky pain and preserved consciousness, but you are concerned about a possible symptomatic or ruptured AAA, especially in the presence of cardiovascular instability. While preparing for urgent scanning, they ask which of the following statements accurately reflects NICE NG156 guidance.

Which statement is correct according to NICE NG156?