MP26-13 PREDICTORS OF CT UTILIZATION IN THE EMERGENCY DEPARTMENT FOR CHILDREN WITH NEPHROLITHIASIS

Abstract

You have accessJournal of UrologyPediatrics: Testis, Varicocele & Stones1 Apr 2014MP26-13 PREDICTORS OF CT UTILIZATION IN THE EMERGENCY DEPARTMENT FOR CHILDREN WITH NEPHROLITHIASIS Justin Ziemba, Douglas Canning, Jane Lavelle, and Gregory Tasian Justin ZiembaJustin Ziemba More articles by this author , Douglas CanningDouglas Canning More articles by this author , Jane LavelleJane Lavelle More articles by this author , and Gregory TasianGregory Tasian More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.901AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES For children with suspected nephrolithiasis, the AUA recommends ultrasound (US) as the initial imaging modality with CT reserved if US is non-diagnostic. We sought to identify factors influencing initial CT utilization for children who presented to the Emergency Department (ED) with nephrolithiasis. METHODS We performed a cross-sectional study of children ≤18 years with nephrolithiasis who presented to the ED of our children′s hospital or an outside hospital (OSH) within our referral network between 2004 and 2012. The outcome was use of CT as the initial diagnostic test in the ED. Predictor variables included patient demographics and hospital characteristics, which were obtained via an electronic survey sent to referring OSH EDs (Table 1). Variables significantly associated with CT utilization on univariate analysis were included in a hierarchical multivariate logistic regression model controlling for hospital type (e.g. children versus non-children's hospital) to estimate the association between patient and hospital characteristics and CT utilization. RESULTS 539 children who presented to 110 different hospitals were included. There were no demographic differences between the 217 children who presented to our hospital and the 322 who originally presented to an OSH. On multivariate analysis, older age (OR 1.09; 95% CI 1.03-1.15) was associated with higher CT utilization. A more recent year of presentation (OR 0.79; 95% CI 0.72-0.87) and the presence of a clinical pathway where US is the initial diagnostic test for the evaluation of suspected nephrolithiasis (OR 0.01; 95% CI 0.00-0.45) were significantly associated with decreased CT utilization (Table 2). CONCLUSIONS The presence of a clinical pathway in which US is the initial diagnostic test for the evaluation of suspected nephrolithiasis was associated with decreased CT utilization. Implementation of care pathways may lead to lower radiation exposure and better adherence to AUA guidelines. Table 2. Adjusted Odds Ratios for the Association Between Patient and Hospital Characteristics and CT Utilization in the ED OR 95% CI p-Value Age at Diagnosis (years) 1.09 1.03-1.15 0.002 Gender 1.07 0.61-1.89 0.793 Year of Diagnosis 0.79 0.72-0.87 <0.001 Pediatric ED Size (no. beds) 0.72 0.04-11.54 0.815 Pediatric ED Volume (visits/year) 2.26 0.80-6.39 0.124 US Availability (24 hrs/day) 0.20 0.00-37.50 0.544 CT Availability (24 hrs/day) 0.58 0.00-111.73 0.839 Stone Algorithm (Present) 0.01 0.00-0.45 0.017 OR=odds ratio; CI=confidence interval Table 1. Survey Responses from Referring Emergency Departments Question Response Rate (n=14) Time To Hospital (%) ≤30 Min 5 (36) >30 Min 9 (64) Practice Location (%) Suburban 11 (79) Urban 3 (21) Practice Environment (%) Academic 5 (36) Non-Academic 9 (64) Children's Hospital Affiliate (%) Yes 5 (36) No 9 (64) Trauma Center (%) Yes 2 (14) No 12 (86) Total Emergency Room Beds (%) ≤30 9 (64) >30 5 (36) Dedicated Pediatric Emergency Room (%) Yes 5 (36) No 9 (64) Total Pediatric Emergency Room Beds† (%) ≤5 2 (40) >5 3 (60) General Pediatrician Available for Consultation (%) Yes 11 (79) No 3 (21) Urologist Available for Consultation (%) Yes 12 (86) No 2 (14) Pediatric Urologist Available for Consultation‡ (%) Yes 1 (8) No 11 (92) CT Scanner in the Emergency Room (%) Yes 11 (79) No 3 (21) Ultrasound Available (%) Yes 14 (100) No 0 (0) Ultrasound Available 24 Hours per Day (%) Yes 11 (79) No 3 (21) Radiologist Reads Emergency Room Films (%) Yes 13 (93) No 1 (7) Radiologist Available 24 Hours per Day‡ (%) Yes 6 (50) No 6 (50) Annual Patients Evaluated in Emergency Room (%) ≤50,000 8 (57) >50,000 6 (43) Annual Pediatric Patients Evaluated in Emergency Room (%) ≤10,000 7 (50) >10,000 7 (50) Clinical Pathway for Evaluation of Suspected Nephrolithiasis (%) Yes 1 (7) No 13 (93) † Only includes respondents with a dedicated pediatric emergency room ‡ Only 12 respondents © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e256 Peer Review Report Advertisement Copyright & Permissions© 2014MetricsAuthor Information Justin Ziemba More articles by this author Douglas Canning More articles by this author Jane Lavelle More articles by this author Gregory Tasian More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...