Ordon Michael, Bota Sarah E, Kang Yuguang, Welk Blayne
Division of Urology, Department of Surgery, St. Michael's Hospital, Toronto, Canada.
Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
J Endourol. 2023 Jul;37(7):834-842. doi: 10.1089/end.2023.0068.
To determine the incidence of and risk factors for imaging in patients presenting to the emergency department (ED) with renal colic. We conducted a population-based cohort study in the province of Ontario, utilizing linked administrative health data. Patients who presented to an ED with renal colic between April 1, 2010, and June 30, 2020, were included. The rate of initial imaging (CT scans and ultrasound [U/S]) and repeat imaging within 30 days was determined. Generalized linear models were utilized to evaluate patient and institutional-level characteristics associated with imaging, and specifically CT U/S. There were 397,491 index renal colic events, of which 67% underwent imaging (CT 68%, U/S 27%, and CT+U/S same day 5%). Repeat imaging was performed in 21% of events (U/S in 12.5%, CT in 8.4%) at a median of 10 days. Of those with an initial U/S, 28% had repeat imaging compared with 18.5% for those with an initial CT. Undergoing an initial CT was associated with being male, urban residence, later year of cohort entry, history of diabetes mellitus and inflammatory bowel disease, and presentation to nonacademic hospitals of larger size, or with a higher volume of ED visits. Two-thirds of renal colic patients underwent imaging, and CT was the most utilized modality. Patients undergoing an initial CT had a lower likelihood of repeat imaging within 30 days. The utilization of CT increased over time and was more common in males and those presenting to nonacademic hospitals of larger size, or with higher ED volumes. Our study highlights the patient- and institution-level factors that need to be targeted with prevention strategies to reduce the utilization of CT scans, when possible, for cost reduction and to minimize patient exposure to ionizing radiation.
确定因肾绞痛就诊于急诊科（ED）的患者进行影像学检查的发生率及危险因素。我们在安大略省开展了一项基于人群的队列研究，利用了关联的行政健康数据。纳入了2010年4月1日至2020年6月30日期间因肾绞痛就诊于急诊科的患者。确定了初始影像学检查（CT扫描和超声[U/S]）及30天内重复影像学检查的发生率。采用广义线性模型评估与影像学检查相关的患者和机构层面特征，特别是CT与U/S。共有397491例首次肾绞痛事件，其中67%接受了影像学检查（CT占68%，U/S占27%，同日CT + U/S占5%）。21%的事件进行了重复影像学检查（U/S占12.5%，CT占8.4%），中位时间为10天。初始检查为U/S的患者中，28%进行了重复影像学检查，而初始检查为CT的患者这一比例为18.5%。初始接受CT检查与男性、城市居住、队列进入年份较晚、有糖尿病和炎症性肠病病史、就诊于规模较大的非学术医院或急诊科就诊量较高有关。三分之二的肾绞痛患者接受了影像学检查，CT是最常用的检查方式。初始接受CT检查的患者在30天内进行重复影像学检查的可能性较低。CT的使用随时间增加，在男性以及就诊于规模较大的非学术医院或急诊科就诊量较高的患者中更为常见。我们的研究强调了患者和机构层面的因素，需要针对这些因素制定预防策略，以在可能的情况下减少CT扫描的使用，从而降低成本并尽量减少患者暴露于电离辐射。
