Format

Send to

Choose Destination
See comment in PubMed Commons below
J Urol. 2017 Jun 23. pii: S0022-5347(17)76731-6. doi: 10.1016/j.juro.2017.06.077. [Epub ahead of print]

Predictors of Hospital Admission and Urologic Intervention in Adult Emergency Department Patients with CT-confirmed Ureteral Stones.

Author information

1
University of California, Davis, School of Medicine. Department of Emergency Medicine.
2
University of Massachusetts Medical School - Baystate, Department of Emergency Medicine.
3
Yale University School of Medicine. Department of Emergency Medicine.
4
Yale University School of Medicine. Department of Urology.

Abstract

PURPOSE:

Over one million patients seek care in an Emergency Department (ED) for kidney stones annually, but a minority require admission or urologic procedure. We aim to describe predictors of hospital admission or urologic intervention.

MATERIALS AND METHODS:

This secondary analysis of prospective data includes ED patients with CT-confirmed obstructing ureteral stone. All patients also received a point-of-care limited renal ultrasound (PLUS). Need for urologic intervention at 90 days was assessed by follow-up interview. Logistic regression was used to identify predictors of admission and urologic intervention, which were further stratified by disposition. Separate regression models with and without CT findings (PLUS only) were compared using the c-statistic.

RESULTS:

Among a cohort of 475 patients with symptomatic stone on CT, 95 (20%) were admitted and 68 had an intervention (72%). Of 380 discharged patients, 66 (17%) required urologic intervention. Admitted patients were more likely to have had a prior procedure, evidence of kidney injury or infection, need opiate analgesia, have larger stones or hydronephrosis on PLUS. Predictors of intervention varied by disposition, though regression models with and without CT findings demonstrated similar c-statistics. Discharged patients with larger stones, a longer duration of pain at presentation, and prior procedures were more likely to undergo intervention.

CONCLUSIONS:

Intervention was common among admitted patients but occurred in a minority of those discharged. Predictors of intervention varied by disposition and models incorporating CT findings were similar to those without. These data support ultrasound-first or delayed-CT diagnostic pathways for patients deemed clinically suitable for discharge.

KEYWORDS:

Diagnostic Imaging; Kidney Calculi; Ultrasound

PMID:
28652122
DOI:
10.1016/j.juro.2017.06.077
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Support Center