Hyams Elias S, Matlaga Brian R, Korley Frederick K
Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD, USA.
Can J Urol. 2012 Aug;19(4):6351-9.
The emergency department (ED) is a common setting for evaluation of patients with urolithiasis based on acute symptoms and a propensity for recurrent disease. We sought to characterize practice patterns in the emergency treatment of stone disease, and to identify potential disparities in care based on non-medical factors.
We performed a cross-sectional analysis of ED visits using the National Hospital Ambulatory Medical Care Survey from 2005-2009. Visits with a diagnosis of urolithiasis were identified. The associations between patient, provider and institutional characteristics were analyzed with regard to timing of clinical assessment, use of diagnostic imaging, and use of medical expulsive therapy (MET).
The likelihood of a delay in clinical assessment ranged from 30.8%-37.9%. Neither patient nor provider characteristics were associated with a delay in assessment, although urban location (p = 0.004) was more likely, and proprietary ownership was less likely (p = 0.002) to be associated with delay. Factors associated with use of CT included ambulance arrival (p = 0.043), initial ED visit (p = 0.000), and Northeast region (p = 0.030). Patients seen by a resident/intern were more likely to receive MET (p = 0.028). Overall, 10.8% of patients were presenting for follow up treatment, and 7.1% had been seen in the same ED within the last 72 hours.
Kidney stones are associated with a high rate of repeated presentations to the ED. Certain non-medical factors did impact details of management. Future efforts should focus on optimizing clinical pathways to improve the efficiency of acute care for kidney stone patients.
急诊科是根据急性症状和疾病复发倾向对尿石症患者进行评估的常见场所。我们试图描述结石病急诊治疗的实践模式，并确定基于非医疗因素的潜在护理差异。
我们使用2005 - 2009年国家医院门诊医疗调查对急诊科就诊情况进行了横断面分析。确定诊断为尿石症的就诊病例。分析了患者、提供者和机构特征与临床评估时间、诊断性影像学检查的使用以及药物排石治疗（MET）的使用之间的关联。
临床评估延迟的可能性在30.8% - 37.9%之间。患者和提供者特征均与评估延迟无关，尽管城市地区（p = 0.004）更有可能，而私立医院则不太可能（p = 0.002）与延迟相关。与使用CT相关的因素包括救护车送达（p = 0.043）、首次急诊科就诊（p = 0.000）和东北地区（p = 0.030）。由住院医师/实习医生诊治的患者更有可能接受MET（p = 0.028）。总体而言，10.8%的患者前来接受后续治疗，7.1%的患者在过去72小时内在同一家急诊科就诊过。
肾结石与高比例的反复到急诊科就诊相关。某些非医疗因素确实影响了管理细节。未来的努力应集中在优化临床路径，以提高肾结石患者急性护理的效率。
