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Urology Consultation and Emergency Department Revisits for Children with Urinary Stone Disease.

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2018 Jul

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<p><strong>PURPOSE: </strong>To determine the association between urology consultation and emergency department (ED) revisits for children with urinary stones.</p>

<p><strong>MATERIALS AND METHODS: </strong>This retrospective cohort study included patients ≤18 years-old who presented to an ED in South Carolina with a urinary stone from 1997-2015. The primary exposure was urology consultation during the index ED visit. The primary outcome was a stone-related ED revisit occurring within 180 days of discharge from an index ED visit. Secondary outcomes included CT utilization, inpatient admission, and emergent surgery.</p>

<p><strong>RESULTS: </strong>Among 5,642 index ED visits for acute urinary stones, 11% resulted in at least one stone-related ED revisit within 180 days. Fifty-nine percent of revisits occurred within 30-days of discharge and 39% were due to pain. The odds of ED revisit were highest within the first 48-hours of discharge (odds ratio [OR] 22.6, 95% confidence interval [CI] 18.0-28.5) and rapidly decreased thereafter. Urology consultation was associated with a 37% lower adjusted odds of ED revisit (OR 0.63, 95% CI 0.44-0.90) and 68% lower odds of CT utilization across all ED visits (OR 0.32, 95% CI 0.15-0.69). Among those who revisited, the frequency of pain complaints was 27% among those with urologic consultation at the index visit and 39% among those without.</p>

<p><strong>CONCLUSIONS: </strong>Urology consultation was associated with decreased ED revisits and CT imaging among pediatric patients with urinary stones. Future studies should identify the patients that benefit most from urology consultation and ascertain processes of care that decrease ED revisits among high-risk patients.</p>






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