MP70-17 IMPLEMENTATION OF AN ED NEPHROLITHIASIS PROTOCOL INCREASES USE OF MEDICAL EXPULSIVE THERAPY IN THE PEDIATRIC POPULATION

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP70-17 IMPLEMENTATION OF AN ED NEPHROLITHIASIS PROTOCOL INCREASES USE OF MEDICAL EXPULSIVE THERAPY IN THE PEDIATRIC POPULATION Daniel Salevitz, Chung-Yon Lin, Bernice Alcanzo, Abhijeet Namjoshi, Philip Lee, Cecilia Monteilh, and Gwen Grimsby Daniel SalevitzDaniel Salevitz More articles by this author , Chung-Yon LinChung-Yon Lin More articles by this author , Bernice AlcanzoBernice Alcanzo More articles by this author , Abhijeet NamjoshiAbhijeet Namjoshi More articles by this author , Philip LeePhilip Lee More articles by this author , Cecilia MonteilhCecilia Monteilh More articles by this author , and Gwen GrimsbyGwen Grimsby More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A review of children presenting to our emergency department (ED) from 2011 to 2017 found that ureteral stone passage was significantly higher for those prescribed medical expulsive therapy (MET), versus analgesics alone (45% vs 20%, p<0.0001). Urology consultation was also associated with increased MET use (p<0.0001). As a result, a new nephrolithiasis management protocol was implemented at our ED in August 2017 with the goal of increasing MET usage, decreasing use of CT scans, and increasing outpatient referrals to Urology and Nephrology. METHODS: This is a retrospective study of children aged 2 months to 18 years old who presented to a quaternary children’s hospital ED with an ICD-9 or ICD-10 diagnosis of urolithiasis from August 2017 to April 2022. Basic demographics, MET prescribing, use of CT for stone diagnosis, opioid prescription rate, and referral to Urology and Nephrology were compared before and after implementation of the ED nephrolithiasis protocol. Statistical analysis was performed using two sample t-test analysis and Fisher’s exact test. RESULTS: A total of 124 patients met inclusion criteria. Mean age was 14 years (SD 3.64), 47 (38%) male. Comparing pre and post-protocol implementation, there was no difference in mean age, gender, or stone size between groups (Table 1). Post-protocol, 99 patients (80%) were prescribed MET, which was significantly higher compared with 54% prior to the protocol (p<0.0001). Patients prescribed MET were older (mean 16 vs 15, p=0.014), and a higher proportion were discharged from the ED (71% vs 48%, p=0.033). Post protocol significantly less patients were prescribed opioids (27% vs 44%, p=0.0069). There was no difference in use of CT scans (79% vs 70%, p=0.1169), return to the ED (14% vs 14%, p=0.8681), outpatient urology (89% vs 89%, p=1.0) or nephrology referrals (23% vs 22%, p=1.0) pre and post protocol implementation, Table 1. CONCLUSIONS: After implementation of an ED nephrolithiasis protocol, use of MET for ureteral stones increased and prescription of opioids decreased. There was no difference in use of CT scans or outpatient referral to Urology and Nephrology pre versus post-protocol. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1010 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Salevitz More articles by this author Chung-Yon Lin More articles by this author Bernice Alcanzo More articles by this author Abhijeet Namjoshi More articles by this author Philip Lee More articles by this author Cecilia Monteilh More articles by this author Gwen Grimsby More articles by this author Expand All Advertisement PDF downloadLoading ...