Urology consultation cuts ED revisits, CT use in paediatric patients with urinary stones.
Urology consultation appears to lessen emergency department (ED) revisits and computed tomography (CT) use in paediatric patients with urinary stones, reports a recent study.
In total, 5,642 index ED visits for acute urinary stones were recorded, of which 11 percent led to at least one stone-related ED revisit within 180 days. Of these revisits, 59 percent occurred within 30 days of discharge and 39 percent were caused by pain. The highest odds of ED revisit were within the first 48 hours of discharge home (odds ratio [OR], 22.6; 95 percent CI, 18.0–28.5) and rapidly decreased later.
Urology consultation correlated with 37-percent lower adjusted odds of ED revisit (OR, 0.63; 0.44–0.90) and 68-percent reduced odds of CT use across all ED visits (OR, 0.32; 0.15–0.69). The frequency of pain complaints among patients who had ED revisits was 27 percent in those with a urological consultation at the index visit and 39 percent in those without.
In this retrospective cohort study, patients aged ≤18 years who presented to an ED in South Carolina with a urinary stone from 1997–2015 were included. Urology consultation during the index ED visit was the primary exposure.
The primary outcome was a stone-related ED revisit occurring within 180 days of discharge from an index ED visit, while secondary outcomes included use of CT, inpatient admission and emergent surgery.
“Future studies should identify patients who benefit most from urology consultation and ascertain processes of care that decrease ED revisits among high-risk patients,” the investigators said.