Garcia Kyle, Pham Hannah, Sharma Pranav
J Healthc Qual. 2019 Sep/Oct;41(5):e47-e53. doi: 10.1097/JHQ.0000000000000165.
A subset of patients with ureteral stones who present to the emergency department (ED) will return with recurring symptoms and will receive unnecessary repeat imaging. We retrospectively identified 112 patients from 2012 to 2016 diagnosed with at least one ureteral stone on computerized tomography (CT) at our institution who returned to the ED within 30 days. Patients were stratified based on the presence or absence of repeat CT scan imaging. Mean values were compared with independent t-test and proportions with chi-square analysis. Multivariate logistic regression was performed to determine independent predictors of repeat imaging. Sixty-eight patients (60.7%) underwent repeat CT scan imaging upon representation to the ED within 30 days of being diagnosed with ureterolithiasis. Ureteral stone position changed in 34 patients (30.4%) who underwent repeat imaging. On univariate analysis, younger age, nondiabetics, narcotics prescribed on discharge from first ED visit, and longer mean time between ED visits were associated with repeat CT scan imaging being performed (p < .05). Only prescription of narcotic pain medications was an independent predictor of repeat CT scan imaging (odds ratio: 3.18, 95% confidence interval: 1.22-8.28; p = .018). Nonsteroidal anti-inflammatory drugs or nonnarcotic pain medications, therefore, should primarily be used for pain control in these patients to avoid unnecessary testing.
一部分因输尿管结石到急诊科就诊的患者会出现反复症状并接受不必要的重复影像学检查。我们回顾性地确定了2012年至2016年间在我院经计算机断层扫描（CT）诊断出至少有一枚输尿管结石且在30天内返回急诊科的112例患者。根据是否进行重复CT扫描成像对患者进行分层。采用独立样本t检验比较均值，采用卡方分析比较比例。进行多因素逻辑回归分析以确定重复成像的独立预测因素。68例患者（60.7%）在被诊断为输尿管结石后30天内到急诊科就诊时接受了重复CT扫描成像。接受重复成像的34例患者（30.4%）输尿管结石位置发生了变化。单因素分析显示，年龄较小、非糖尿病患者、首次急诊科就诊出院时开具了麻醉药品以及两次急诊科就诊之间的平均时间较长与进行重复CT扫描成像相关（p<0.05）。只有麻醉性止痛药物的处方是重复CT扫描成像的独立预测因素（比值比：3.18，95%置信区间：1.22 - 8.28；p = 0.018）。因此，在这些患者中应主要使用非甾体抗炎药或非麻醉性止痛药物来控制疼痛，以避免不必要的检查。
