First name
Jonathan
Middle name
S
Last name
Ellison

Title

Variation in care between pediatric and adult patients presenting with nephrolithiasis to tertiary care pediatric emergency departments in the United States (2009-2020).

Year of Publication

2022

Date Published

07/2022

ISSN Number

1873-4898

Abstract

BACKGROUND: Individuals with nephrolithiasis frequently present to the Emergency Department (ED). Safety and quality principles are often applied in pediatric EDs to children presenting with nephrolithiasis, such as limiting ionizing radiation exposure and opioid analgesics. However, it is unknown whether pediatric EDs apply these same principles to adult patients who present with nephrolithiasis. We hypothesized that adult patients would be associated with higher use of radiation-based imaging and opioid analgesics.

OBJECTIVE: To assess variations in diagnostic and treatment interventions and hospital utilization between pediatric and adult patients presenting to the pediatric ED with nephrolithiasis.

STUDY DESIGN: A retrospective cohort study was conducted, examining outcomes for pediatric (<18-years-old) versus adult (≥18-years-old) patients in 42 pediatric EDs from 2009 to 2020 using the Pediatric Health Information System (PHIS) database. Patients with an ICD-9/10 principal diagnosis code of nephrolithiasis with no nephrolithiasis-related visits within the prior 6 months were included. Primary outcomes were imaging, medications, and surgical interventions. Secondary outcomes were hospital admissions, 90-day ED revisits, and 90-day readmissions. Generalized linear mixed models with random effects were used to adjust for confounding and clustering.

RESULTS: In total, 16,117 patients with 17,837 encounters were included. Most hospitals were academic (95.2%), and a plurality were located in the South (38.1%). Most patients were <18-years-old (84.4%, median (interquartile range): 15 (12-17)-years-old), female (57.9%), and White (76.3%), and 17.1% were Hispanic/Latino. Most had no complex chronic conditions (89.2%) and no chronic disease per pediatric medical complexity algorithm (51.5%). For the primary outcome, adults, relative to pediatric patients, who presented to the pediatric ED with nephrolithiasis had higher adjusted odds of receiving computerized tomography (CT) scans (Odds Ratio [OR] 1.43 [95% Confidence Interval [CI] 1.29-1.59]) and opioid analgesics (OR 1.45 [95%CI 1.33-1.58]) (Summary Figure). Secondary outcomes showed that adults, relative to pediatric patients, had lower adjusted odds of hospital admissions, 90-day ED revisits, and 90-day readmissions.

DISCUSSION: Our results suggest that certain pediatric safety and quality principles, such as limiting ionizing radiation exposure and opioid analgesic prescriptions, are not being equally applied to pediatric and adult patients who present to pediatric EDs with nephrolithiasis. The mechanism of these findings remains to be elucidated.

CONCLUSIONS: Variations in care for individuals with nephrolithiasis reflect an opportunity for quality improvement in pediatric EDs and inform work exploring optimal care pathways for all patients presenting to the pediatric ED with nephrolithiasis.

DOI

10.1016/j.jpurol.2022.07.005

Alternate Title

J Pediatr Urol

PMID

35945144

Title

The Impact of Sex and Gender on Clinical Care and Research Design in Nephrolithiasis.

Year of Publication

2021

Number of Pages

54-57

Date Published

2021 05

ISSN Number

1527-9995

Abstract

<p>Although classically a disease of male preponderance, scrutiny of the available data on&nbsp;nephrolithiasis&nbsp;reveals substantial epidemiological discrepancies between males and females, suggesting sex-based&nbsp;pathophysiology&nbsp;underlying this disease.&nbsp;Furthermore, sex-based differences may exist in underlying urinary risk factors, presentation, and treatment response. Recognizing these differences will be essential to further understand the multitude of etiologies of kidney stone disease and aid in developing appropriately designed comparative effectiveness trials.</p>

DOI

10.1016/j.urology.2020.04.089

Alternate Title

Urology

PMID

32387245

Title

Laser access and utilization preferences for pediatric ureteroscopy: A survey of the Societies of Pediatric Urology.

Year of Publication

2021

Date Published

2021 Oct 18

ISSN Number

1911-6470

Abstract

<p><strong>INTRODUCTION: </strong>We sought to evaluate laser access and practice variability for pediatric ureteroscopy (URS) across the Societies of Pediatric Urology (SPU) to identify opportunities and barriers for future technology promulgation and evidence dissemination.</p>

<p><strong>METHODS: </strong>A 25-question survey was sent electronically to members of the SPU. The questionnaire assessed surgeon and hospital characteristics, treatment preferences based on an index case, and information about available laser units. Descriptive and comparative statistical analyses were performed to assess patterns of care and laser accessibility across the SPU.</p>

<p><strong>RESULTS: </strong>A total of 105 of 711 (15%) recipients responded. Seventy-seven respondents (73%) reported laser ownership, which was associated with greater after-hours laser access (87% vs. 13%, p&lt;0.01). Fifty-eight individuals provided additional laser specifications, of whom 21 (36%) used a high-power laser unit (&gt;60 W). Standard-power lasers were used more frequently in free-standing children's hospitals, as compared to those working within a larger hospital complex (75% vs. 50%, p=0.049). Variation existed in treatment preferences with respect to dusting (33, 34%), fragmentation (18, 19%), or a hybrid approach (46 respondents, 48%). Stone clearance was the most important consideration irrespective of treatment choice.</p>

<p><strong>CONCLUSIONS: </strong>Variability in surgical preferences and accessibility to laser units exist across pediatric urologists who performing URS. Laser ownership and access to newer technologies vary across practices and may influence treatment options. Understanding access to laser technology will be important when considering opportunities for surgical optimization to improve patient outcomes through future studies.</p>

DOI

10.5489/cuaj.7326

Alternate Title

Can Urol Assoc J

PMID

34672934

Title

Early-Onset Kidney Stone Disease-Consequences and Opportunities.

Year of Publication

2021

Date Published

2021 Sep 07

ISSN Number

2168-6211

DOI

10.1001/jamapediatrics.2021.2966

Alternate Title

JAMA Pediatr

PMID

34491264

Title

Measuring patient-centered outcomes: The need to move beyond quality of life.

Year of Publication

2021

Date Published

2021 Apr 03

ISSN Number

1873-4898

DOI

10.1016/j.jpurol.2021.03.033

Alternate Title

J Pediatr Urol

PMID

33893039

Title

The Surgical Improvement Cycle: Improving Surgical Outcomes through Partnerships and Rigor.

Year of Publication

2021

Number of Pages

101097JU0000000000001626

Date Published

2021 Jan 27

ISSN Number

1527-3792

DOI

10.1097/JU.0000000000001626

Alternate Title

J Urol

PMID

33502238

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