卡塔尔多哈和澳大利亚墨尔本急诊科急性肾绞痛就诊情况的一项对比性流行病学研究。
A comparative, epidemiological study of acute renal colic presentations to emergency departments in Doha, Qatar, and Melbourne, Australia.
作者信息
Pathan Sameer A, Mitra Biswadev, Bhutta Zain A, Qureshi Isma, Spencer Elle, Hameed Asmaa A, Nadeem Sana, Tahir Ramsha, Anjum Shahzad, Cameron Peter A
机构信息
Emergency Department, Hamad General Hospital, Hamad Medical Corporation, P.O.BOX 3050, Doha, Qatar.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
出版信息
Int J Emerg Med. 2018 Jan 3;11(1):1. doi: 10.1186/s12245-017-0160-9.
BACKGROUND
This study aimed to compare the epidemiology, clinical presentations, management, and outcomes of renal colic presentations in two major academic centers from geographically diverse populations: Qatar (a country in the Afro-Asian stone belt) and South-Eastern Australia (not within a stone belt).
METHODS
We undertook a retrospective cohort study of patients with renal colic who presented to the Hamad General Hospital Emergency Department (HGH-ED), Qatar, and The Alfred ED, Melbourne, Australia, during a period of 1 year from August 1, 2012, to July 31, 2013. Cases were identified using ICD-9-CM codes, and an electronic template was used to record the data on predefined clinical variables.
RESULTS
A total of 12,223 from the HGH-ED and 384 from The Alfred ED were identified as renal colic presentations during the study period. The rate of renal colic presentations at the HGH-ED was 27.9 per 1000 ED visits compared to 6.7 per 1000 ED visits at The Alfred ED. Patients presenting to the HGH-ED were significantly younger [34.9 years (29.0-43.4) than The Alfred ED [48 years (37-60); P < 0.001]. The median stone size was larger in the HGH-ED group [6 (4-8) mm] versus The Alfred ED group [4 (3-6) mm, P < 0.001]. The intervention rate in the stone-positive population was significantly higher in the HGH-ED group as opposed to The Alfred ED group (38.7 versus 11.9%, P < 0.001). At the time of discharge, The Alfred ED group received fewer analgesic prescriptions (55.8 versus 83.5%, P < 0.001) and more tamsulosin prescriptions (25.3 versus 11.7%, P < 0.001).
CONCLUSIONS
Renal colic presentations to the HGH-ED, Qatar, were younger, with larger stone size mostly located in the lower ureter, compared to The Alfred ED, Melbourne, Australia. The findings suggest that the benefits of treatment including medical expulsion therapy will vary between the two populations. Differences in epidemiology and patient mix should be considered while tailoring strategies for effective management of patients with renal colic in a given setting.
背景
本研究旨在比较来自地理上不同人群的两个主要学术中心的肾绞痛患者的流行病学、临床表现、治疗及预后情况：卡塔尔（亚非结石带的一个国家）和澳大利亚东南部（不在结石带内）。
方法
我们对2012年8月1日至2013年7月31日期间在卡塔尔哈马德总医院急诊科（HGH - ED）和澳大利亚墨尔本阿尔弗雷德急诊科就诊的肾绞痛患者进行了一项回顾性队列研究。使用ICD - 9 - CM编码识别病例，并使用电子模板记录预定义临床变量的数据。
结果
在研究期间，HGH - ED共识别出12223例肾绞痛患者，阿尔弗雷德急诊科识别出384例。HGH - ED的肾绞痛就诊率为每1000次急诊就诊27.9例，而阿尔弗雷德急诊科为每1000次急诊就诊6.7例。就诊于HGH - ED的患者明显比阿尔弗雷德急诊科的患者年轻[34.9岁（29.0 - 43.4岁）对48岁（37 - 60岁）；P < 0.001]。HGH - ED组的结石中位大小更大[6（4 - 8）mm]，而阿尔弗雷德急诊科组为[4（3 - 6）mm，P < 0.001]。结石阳性人群中的干预率在HGH - ED组显著高于阿尔弗雷德急诊科组（38.7%对11.9%，P < 0.001）。出院时，阿尔弗雷德急诊科组接受的止痛处方较少（55.8%对83.5%，P < 0.001），而坦索罗辛处方较多（25.3%对11.7%，P < 0.001）。
结论
与澳大利亚墨尔本的阿尔弗雷德急诊科相比，卡塔尔HGH - ED的肾绞痛患者更年轻，结石更大，且大多位于输尿管下段。研究结果表明，包括药物排石疗法在内的治疗益处在这两个人群中会有所不同。在为特定环境下的肾绞痛患者制定有效管理策略时，应考虑流行病学和患者构成的差异。
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