Department of Nephrology and Hypertension, Inselspital, University of Bern, Bern, Switzerland.
BMC Nephrol. 2012 Sep 24;13:117. doi: 10.1186/1471-2369-13-117.
Urolithiasis is one of the most common conditions seen in emergency departments (ED) worldwide, with an increasing frequency in geriatric patients (>65 years). Given the high costs of emergency medical urolithiasis treatment, the need to optimise management is obvious. We aimed to determine risk factors for hospitalisation and evaluate diagnostic and emergency treatment patterns by ED physicians in geriatric urolithiasis patients to assist in optimising treatment.
After receiving ethics committee approval, we examined the records of emergency urolithiasis admissions to our ED between January 2000 and December 2010 to determine risk factors for hospitalisation and to evaluate current diagnostic and emergency treatment patterns in geriatric urolithiasis patients.
1,267 consecutive patients at least 20 years of age with confirmed urolithiasis (1,361 ED visits) and complete follow-up data were analyzed. Geriatric patients comprised 10% of urolithiasis patients with more than half of them experiencing their first urolithiasis episode at ED admission. Although stone site, side and size did not significantly differ between groups, urinary stone disease was more severe in the elderly. The risk of severe complications correlated with increasing age, female sex and diabetes mellitus. Geriatric patients had a two-fold greater likelihood of being hospitalised. A significantly lower percentage of geriatric patients received combined analgesic therapy for pain management (37% vs. 64%, p = <0.001) and supportive expulsive treatment (9% vs. 24%, p = <0.001).
Geriatric patients with urolithiasis have a higher morbidity than younger patients and may be undertreated concerning analgetic and expulsive treatment in ED.
尿石症是全球急诊科（ED）最常见的疾病之一，老年患者（>65 岁）的发病率不断增加。鉴于急诊治疗尿石症的医疗费用高昂，显然需要优化管理。我们旨在确定老年尿石症患者住院的危险因素，并评估 ED 医生的诊断和急诊治疗模式，以协助优化治疗。
在获得伦理委员会批准后，我们检查了 2000 年 1 月至 2010 年 12 月期间我们急诊科急诊尿石症入院患者的记录，以确定住院的危险因素，并评估老年尿石症患者的当前诊断和急诊治疗模式。
分析了 10%至少 20 岁确诊为尿石症（1361 次 ED 就诊）且有完整随访数据的连续患者。老年患者占尿石症患者的一半以上，其中一半以上在 ED 就诊时首次出现尿石症。尽管结石部位、侧位和大小在两组之间无显著差异，但老年患者的尿石症更严重。严重并发症的风险与年龄增长、女性和糖尿病相关。老年患者住院的可能性是年轻患者的两倍。接受联合镇痛治疗以进行疼痛管理的老年患者比例明显较低（37%比 64%，p <0.001），接受支持性促排石治疗的比例也明显较低（9%比 24%，p <0.001）。
与年轻患者相比，老年尿石症患者的发病率更高，并且在 ED 中可能接受的镇痛和促排石治疗不足。
