MP43-08 UTILIZATION OF MEDICAL EXPULSIVE THERAPY IN CHILDREN: AN ASSESSMENT OF NATIONWIDE PRACTICE PATTERNS AND OUTCOMES

Abstract

You have accessJournal of UrologyPediatrics: Testis, Varicocele & Stones1 Apr 2016MP43-08 UTILIZATION OF MEDICAL EXPULSIVE THERAPY IN CHILDREN: AN ASSESSMENT OF NATIONWIDE PRACTICE PATTERNS AND OUTCOMES Jonathan Ellison, Benjamin Fu, Sarah Holt, Thomas Lendvay, John Gore, and Margarett Shnorhavorian Jonathan EllisonJonathan Ellison More articles by this author , Benjamin FuBenjamin Fu More articles by this author , Sarah HoltSarah Holt More articles by this author , Thomas LendvayThomas Lendvay More articles by this author , John GoreJohn Gore More articles by this author , and Margarett ShnorhavorianMargarett Shnorhavorian More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.217AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Medical expulsive therapy (MET) has been proposed to be an efficacious strategy for management of ureteral calculi in children. However, little is known regarding MET utilization within this patient population. We sought to evaluate to utilization and outcomes of MET in pediatric nephrolithiasis utilizing a nationally-representative administrative claims database. METHODS We interrogated the MarketScan Commercial Claims and Encounters database from 2007-2013 to identify children aged 1 to 18 years presenting to the emergency department (ED) with a diagnosis of nephrolithiasis. Patients not considered candidates for MET (i.e. coding for renal insufficiency, urinary tract infection, or surgical intervention at time of evaluation) were excluded. MET exposure was defined as having a prescription for an MET agent (alpha-adrenergic blocker or nifedipine) filled within 1 week of the ED encounter. Patient and provider characteristics were described and outcomes within 90 days of index encounter compared between patients with and without MET exposure. Sub-analysis was performed for patients with the specific diagnosis of ″calculus of the ureter″. RESULTS A total of 1356 patients were included in the study, of which 175 (15.1%) received MET. Of the 437 (32.2%) patients with the diagnosis ″calculus of the ureter″, 68 (16%) received MET. Tamsulosin was utilized in 166 (94.5%) of patients receiving MET. Male gender, any inpatient or outpatient encounter within 3-months of index encounter, and urologist or nephrologist involvement in care were positively associated with MET prescriptions. Rates of ED or inpatient encounters and surgical interventions did not differ by MET exposure (see Table). Only 62% of patients with ureteral calculi had follow-up imaging within 90 days. CONCLUSIONS MET is prescribed infrequently to children who are potential candidates for expulsive therapy. Prescribing patterns vary based on patient- and provider-level factors, and provider familiarity with nephrolithiasis may influence practice patterns. MET exposure was not associated with differences in unplanned medical encounters or need for subsequent surgery. Follow-up imaging is not obtained in 38% of patients with ureteral calculi. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e581 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Jonathan Ellison More articles by this author Benjamin Fu More articles by this author Sarah Holt More articles by this author Thomas Lendvay More articles by this author John Gore More articles by this author Margarett Shnorhavorian More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...