Elder Joshua W, Delgado M Kit, Chung Benjamin I, Pirrotta Elizabeth A, Wang N Ewen
Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut; Department of Internal Medicine, Yale-New Haven Hospital, New Haven, Connecticut; Department of Emergency Medicine, Yale-New Haven Hospital, New Haven, Connecticut.
Department of Emergency Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
J Emerg Med. 2016 Dec;51(6):628-635. doi: 10.1016/j.jemermed.2016.05.037. Epub 2016 Oct 5.
Renal colic results in > 1 million ED visits per year, yet there exists a gap in understanding how the majority of these visits, namely uncomplicated cases, are managed.
We assessed patient- and hospital-level variation for emergency department (ED) management of uncomplicated kidney stones.
We identified ED visits from non-elderly adults (aged 19-79 years) with a primary diagnosis indicating renal stone or colic from the 2011 Nationwide Emergency Department Sample. Patients with additional diagnostic codes indicating infection, sepsis, and abdominal aortic aneurysm were excluded. We used sample-weighted logistic regression to determine the association between hospital admission and having a urologic procedure with patient and hospital characteristics.
Of the 1,061,462 ED visits for uncomplicated kidney stones in 2011, 8.0% of visits resulted in admission and 6.3% resulted in an inpatient urologic procedure. Uninsured patients compared to Medicaid insured patients were less likely to be admitted or have an inpatient urologic procedure (odds ratio [OR] = 0.72; 95% confidence interval [CI] 0.65-0.81 and OR = 0.80; 95% CI 0.72-0.87, respectively). Private- and Medicare-insured patients compared to Medicaid-insured patients were more likely to have an inpatient urologic procedure (OR = 1.20; 95% CI 1.11-1.30 and OR = 1.14; 95% CI 1.04-1.25, respectively).
For patients with uncomplicated renal colic, there is variation in the management associated with nonclinical factors, namely insurance. No consensus guidelines exist yet to address when to admit or utilize inpatient urologic procedures.
肾绞痛每年导致超过100万次急诊就诊，但对于这些就诊中的大多数情况，即非复杂性病例的处理方式，目前仍存在认识上的差距。
我们评估了非复杂性肾结石急诊处理在患者和医院层面的差异。
我们从2011年全国急诊样本中确定了非老年成人（19至79岁）的急诊就诊情况，其主要诊断表明为肾结石或肾绞痛。排除有感染、败血症和腹主动脉瘤等额外诊断代码的患者。我们使用样本加权逻辑回归来确定住院和进行泌尿外科手术与患者及医院特征之间的关联。
2011年，1061462例非复杂性肾结石急诊就诊中，8.0%的就诊导致住院，6.3%的就诊导致进行住院泌尿外科手术。与医疗补助保险患者相比，未参保患者住院或进行住院泌尿外科手术的可能性较小（优势比[OR]=0.72；95%置信区间[CI]为0.65 - 0.81和OR = 0.80；95%CI为0.72 - 0.87）。与医疗补助保险患者相比，私人保险和医疗保险患者进行住院泌尿外科手术的可能性更大（OR = 1.20；95%CI为1.11 - 1.30和OR = 1.14；95%CI为1.04 - 1.25）。
对于非复杂性肾绞痛患者，其处理方式存在与非临床因素（即保险）相关的差异。目前尚无共识指南来指导何时住院或采用住院泌尿外科手术。
