PD47-11 PREDICTORS OF EMERGENCY DEPARTMENT REVISITS FOR URETERAL STONES

Abstract

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II1 Apr 2016PD47-11 PREDICTORS OF EMERGENCY DEPARTMENT REVISITS FOR URETERAL STONES Vishnu Ganesan, Christopher Loftus, Bryan Hinck, Daniel Greene, Yaw Nyame, Sri Sivalingam, and Manoj Monga Vishnu GanesanVishnu Ganesan More articles by this author , Christopher LoftusChristopher Loftus More articles by this author , Bryan HinckBryan Hinck More articles by this author , Daniel GreeneDaniel Greene More articles by this author , Yaw NyameYaw Nyame More articles by this author , Sri SivalingamSri Sivalingam More articles by this author , and Manoj MongaManoj Monga More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2699AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with ureteral stones frequently present to the emergency department (ED) when they first become symptomatic. A proportion of these patients end up returning to the ED. Our objective was to identify predictors among patient characteristics, stone parameters, and management approaches associated with an increased risk of ED revisits. METHODS We analyzed all emergency department visits in the Cleveland Clinic health care network with an ICD-9 diagnosis of nephrolithiasis and a computed tomography (CT) scan between 2010 and 2013. CT scans were independently reviewed to confirm stone size and location and degree of hydronephrosis. The primary outcome was the occurrence of a second ED visit within 30 days of the initial visit for reasons related to the stone. Patient presenting characteristics and stone parameters were recorded. Comparisons among the various factors were computed using a T-test test for numerical data and Fisher exact test for categorical data. A multivariable analysis using logistic regression was used to identify predictive factors for revisit. RESULTS We reviewed the records of 1414 patient > 18 years of age who presented to the ED with a diagnosis of ureteral stones confirmed by CT. Of these, 161 (11%) patients had a revisit to the ED within 30 days. There were no differences in gender, stone size, degree of hydronephrosis, use of alpha blockers, or serum WBC and creatinine between the patients who returned to the ED and those who did not (Table 1). Patients who returned to the ED were more likely to have proximal stones, be < 30 years old, have higher VAS pain score on presentation, and been treated with IV narcotics in their initial visit. On multivariable analysis, presence of a proximal ureteral stone and age < 30 remained independent predictors for a revisit to the ED (Table 2). CONCLUSIONS Patients who present with proximal ureter stones or age less than 30 were strongly associated with return visits to the ED within 30 days. Consideration may be given for early follow-up or intervention. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1174 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Vishnu Ganesan More articles by this author Christopher Loftus More articles by this author Bryan Hinck More articles by this author Daniel Greene More articles by this author Yaw Nyame More articles by this author Sri Sivalingam More articles by this author Manoj Monga More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...