Czajkowski Simon, Lajkosz Katherine, Koziarz Alex, Carr David, Finelli Antonio, Lee Jason Y
Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada.
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Can Urol Assoc J. 2022 Dec;16(12):401-407. doi: 10.5489/cuaj.7909.
Urological presentations to the emergency department (ED) can represent a significant burden of disease. We aimed to evaluate trends in the incidence, management, and followup of urological presentations to the ED at an urban, academic, tertiarycare hospital network over a 10-year period.
A retrospective cohort study was conducted to include all patients presenting with renal colic (RC), gross hematuria (GH), or acute urinary retention (AUR) to EDs in the University Health Network in 2008-2009 and 2018-2019. Patient demographics and outcomes were compared between these two periods and between urological presentations. Multilevel regression analyses identified predictors of in-patient admission, return to the ED, and clinic wait time.
A total of 2751 patients and 3510 ED visits were included (991 visits from 2008-09 and 2519 visits from 2018-19). Over time, increases were observed in all three presentations, largely driven by an almost five-fold increase in RC presentations. Multilevel regression analyses showed that older patients were more likely to be admitted from the ED, while age, 2018-19 era, and residence within the "downtown core" independently predicted return to the ED within 30 days of initial visit. Time to be seen in urology clinic increased over time for the entire cohort, and 14.4% of clinic visits were preceded by multiple ED visits.
The incidence of acute urological presentations increased significantly over a 10-year period at a tertiary-care hospital network. These findings demonstrate an increasing burden of acute urological disease that is outpacing population growth and straining available resources.
泌尿外科疾病在急诊科的就诊情况可能代表着重大的疾病负担。我们旨在评估在一个城市的学术性三级医疗医院网络中，10年间泌尿外科疾病在急诊科的发病率、治疗及随访趋势。
进行一项回顾性队列研究，纳入2008 - 2009年和2018 - 2019年在大学健康网络急诊科就诊的所有肾绞痛（RC）、肉眼血尿（GH）或急性尿潴留（AUR）患者。比较这两个时期以及不同泌尿外科疾病就诊情况之间的患者人口统计学特征和结局。多水平回归分析确定了住院、返回急诊科及门诊等待时间的预测因素。
共纳入2751例患者及3510次急诊科就诊（2008 - 09年991次就诊，2018 - 19年2519次就诊）。随着时间推移，所有三种疾病的就诊人数均有所增加，主要是由肾绞痛就诊人数几乎增加五倍所驱动。多水平回归分析显示，老年患者更有可能从急诊科住院，而年龄、2018 - 19年时期以及居住在“市中心核心区域”独立预测首次就诊后30天内返回急诊科。整个队列在泌尿外科门诊就诊的等待时间随时间增加，14.4%的门诊就诊之前有多次急诊科就诊。
在一个三级医疗医院网络中，10年间急性泌尿外科疾病的发病率显著增加。这些发现表明急性泌尿外科疾病负担不断增加，超过了人口增长速度，使现有资源不堪重负。
