SUNY Downstate College of Medicine, Brooklyn, New York.
Center for Pediatric Clinical Effectiveness, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
J Urol. 2018 Jul;200(1):180-186. doi: 10.1016/j.juro.2018.02.069. Epub 2018 Feb 21.
We determined the association between urology consultation and emergency department revisits for children with urinary stones.
This retrospective cohort study included patients 18 years old or younger who presented to an emergency department in South Carolina with a urinary stone from 1997 to 2015. The primary exposure was urology consultation during the index emergency department visit. The primary outcome was a stone related emergency department revisit occurring within 180 days of discharge from an index emergency department visit. Secondary outcomes included computerized tomography use, inpatient admission and emergent surgery.
Of 5,642 index emergency department visits for acute urinary stones 11% resulted in at least 1 stone related emergency department revisit within 180 days. Of revisits 59% occurred within 30 days of discharge and 39% were due to pain. The odds of emergency department revisit were highest within the first 48 hours of discharge home (OR 22.6, 95% CI 18.0 to 28.5) and rapidly decreased thereafter. Urology consultation was associated with a 37% lower adjusted odds of emergency department revisit (OR 0.63, 95% CI 0.44 to 0.90) and 68% lower odds of computerized tomography use across all emergency department visits (OR 0.32, 95% CI 0.15 to 0.69). Among patients who revisited the emergency department the frequency of pain complaints was 27% in those with a urological consultation at the index visit and 39% in those without.
Urology consultation was associated with decreased emergency department revisits and computerized tomography use in pediatric patients with urinary stones. Future studies should identify patients who benefit most from urology consultation and ascertain processes of care that decrease emergency department revisits among high risk patients.
我们确定泌尿科咨询与儿童尿路结石急诊复诊之间的关联。
本回顾性队列研究纳入了 1997 年至 2015 年期间在南卡罗来纳州因尿路结石就诊于急诊科的 18 岁或以下患者。主要暴露因素为在急诊科就诊时接受泌尿科咨询。主要结果是在急诊科就诊出院后 180 天内发生的与结石相关的急诊复诊。次要结果包括计算机断层扫描使用、住院入院和急诊手术。
在 5642 例急性尿路结石的急诊科就诊中，11%的患者在 180 天内至少有一次与结石相关的急诊科复诊。复诊中有 59%发生在出院后 30 天内，39%是由于疼痛。出院后 48 小时内急诊复诊的可能性最高（OR 22.6，95%CI 18.0 至 28.5），此后迅速下降。泌尿科咨询与急诊复诊的调整后比值比（OR）降低 37%（OR 0.63，95%CI 0.44 至 0.90），与所有急诊科就诊的计算机断层扫描使用率降低 68%（OR 0.32，95%CI 0.15 至 0.69）相关。在复诊的患者中，在索引就诊时接受泌尿科咨询的患者中疼痛投诉的频率为 27%，而未接受咨询的患者中为 39%。
在患有尿路结石的儿科患者中，泌尿科咨询与急诊复诊和计算机断层扫描使用率降低相关。未来的研究应该确定哪些患者最受益于泌尿科咨询，并确定减少高危患者急诊复诊的护理流程。
