Harvard Pediatric Health Services Research Fellowship Program, Harvard Medical School, Boston, Massachusetts, USA.
J Urol. 2010 Oct;184(4 Suppl):1816-22. doi: 10.1016/j.juro.2010.03.117. Epub 2010 Aug 21.
Little is known of current practice patterns for pediatric urolithiasis. We examined recent trends in imaging and surgical management.
The Pediatric Health Information System database is a national database collected at American pediatric hospitals. We searched the database from 1999 to 2008 to identify children diagnosed with urolithiasis. Inpatient hospital admissions, and emergency department and outpatient medical/surgical short stay visits were included. We examined imaging and surgical management trends during the study period using bivariate and multivariate logistic regression models.
We identified 7,921 children diagnosed with urolithiasis during the study period, of whom 1,712 (22%) underwent stone related surgery and 6,318 (80%) underwent stone related diagnostic imaging. The surgery rate remained stable during the study period (p = 0.15), as did the overall imaging rate (p = 0.2). However, computerized tomography use increased (26% to 45%) and plain x-ray of kidneys, ureters and bladder plus excretory urogram use decreased (59% to 38%) during the study period (each p <0.0001). Surgery was associated with older patient age, female gender, white race and private insurance. Computerized tomography use was associated with older patient age, nonwhite race and public insurance. After adjusting for other factors, including hospital region, the treating hospital was most important for predicting surgery or computerized tomography (each p <0.0001).
Surgery and imaging for pediatric urolithiasis remained stable at pediatric hospitals in the last decade, although computerized tomography use has increased. The hospital where a patient receives treatment is the single most important feature driving computerized tomography and surgery use. Patient age, race and insurance status have a smaller but significant role.
目前对于小儿尿路结石的治疗模式所知甚少。我们对其影像学和手术管理的最新趋势进行了研究。
儿科健康信息系统数据库是一个在美国儿科医院收集的全国性数据库。我们对该数据库进行了 1999 年至 2008 年的搜索，以确定诊断为尿路结石的儿童。纳入的患者包括住院患者、急诊部和门诊医疗/外科短期住院患者。我们通过双变量和多变量逻辑回归模型研究了研究期间影像学和手术管理的趋势。
研究期间共确定了 7921 名患有尿路结石的儿童，其中 1712 名（22%）接受了结石相关手术，6318 名（80%）接受了结石相关的影像学检查。在研究期间，手术率保持稳定（p = 0.15），整体影像学率也是如此（p = 0.2）。然而，计算机断层扫描的使用率增加（从 26%增加到 45%），而肾脏、输尿管和膀胱的平片 X 射线加排泄性尿路造影的使用率降低（从 59%降至 38%）（p <0.0001）。手术与患者年龄较大、女性、白人种族和私人保险有关。计算机断层扫描的使用率与患者年龄较大、非白种人种族和公共保险有关。在调整了包括医院所在区域在内的其他因素后，治疗医院是预测手术或计算机断层扫描的最重要因素（p <0.0001）。
在过去十年中，小儿尿路结石的治疗模式在儿科医院保持稳定，尽管计算机断层扫描的使用率有所增加。患者接受治疗的医院是驱动计算机断层扫描和手术使用的最重要单一因素。患者的年龄、种族和保险状况虽然影响较小，但也具有重要意义。
