PURPOSE: We examined trends in visits, hospitalization and charges for patients with upper urinary tract stones presenting to the emergency department (ED) in the United States using the Nationwide Emergency Department Sample (NEDS).
MATERIALS AND METHODS: All visits with a primary diagnosis (ICD-9-CM codes) of kidney calculus (592.0), ureter calculus (592.1) and urinary calculus unspecified (592.9) were extracted from NEDS between 2006-2009. A weighted sample was used to calculate incidence rates. Temporal trends were quantified by estimated annual percent change (EAPC). Patient/hospital characteristics associated with hospitalization were evaluated using logistic regression models adjusted for clustering.
RESULTS: Between 2006-2009 there were 3,635,054 ED visits with upper urinary tract stones. The incidence increased from 289 to 306 per 100,000 individuals. More men visited than women; women demonstrated significant increases in visits (EAPC=+2.85%, p=0.018). Total monthly ED visits ranged from 5.8% (February) to 8.4% (August). Overall, 12.0% were hospitalized and hospitalization rates remained stable (EAPC=-1.02%, p=0.634). Patients were more likely to be hospitalized if female, sicker, seen in an urban teaching or low-volume hospital, and if holding Medicaid or Medicare (all p< 0.001). Sepsis was associated with the highest likelihood of admission (OR=69.64, p< 0.001). In 2009, charges for ED visits increased to $5 billion (EAPC=+10.06%, p=0.003).
CONCLUSIONS: Women demonstrated significant annual increases in ED visits for upper urinary tract stones. While ED charges have risen substantially, hospitalization rates have remained stable. Greater utilization of computed tomography and medical expulsive therapy could be reasons for this observation and warrants further study.
Written by:
Ghani KR, Roghmann F, Sammon JD, Trudeau V, Sukumar S, Rahbar H, Kumar R, Karakiewicz PI, Peabody JO, Menon M, Sun M, Trinh QD. Are you the author?
Vattikuti Urology Institute, Henry Ford Health System, Detroit, USA.
Reference: J Urol. 2013 Aug 7. pii: S0022-5347(13)05092-1.
doi: 10.1016/j.juro.2013.07.098
PubMed Abstract
PMID: 23933053
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