VARIATION IN THE INTENSITY OF CARE FOR PATIENTS WITH UNCOMPLICATED RENAL COLIC PRESENTING TO US EMERGENCY DEPARTMENTS
VARIATION IN THE INTENSITY OF CARE FOR PATIENTS WITH UNCOMPLICATED RENAL COLIC PRESENTING TO US EMERGENCY DEPARTMENTS
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DOI：
10.1016/j.jemermed.2016.05.037
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发表时间：
2016-12-01
影响因子：
1.5
通讯作者：
Wang, N. Ewen
中科院分区：
文献类型：
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作者：
Elder, Joshua W.;Delgado, M. Kit;Wang, N. Ewen
背景：肾绞痛每年导致100万例急诊科就诊，然而在了解这些就诊的大多数，即简单病例，如何处理方面存在差距。目的：我们评估急诊科（ED）对非复杂性肾结石的处理在患者和医院层面的差异。方法：我们从2011年全国急诊科样本中选取了非老年人（19-79岁）就诊的急诊科患者，初步诊断为肾结石或绞痛。有感染、败血症和腹主动脉瘤附加诊断代码的患者被排除在外。我们使用样本加权逻辑回归来确定住院和接受泌尿外科手术与患者和医院特征之间的关系。结果：在2011年因无并发症肾结石就诊的1,061,462例急诊科就诊中，8.0%的就诊导致住院，6.3%导致住院泌尿外科手术。与医疗补助计划参保的患者相比，未参保的患者入院或住院泌尿外科手术的可能性更小（优势比[or] = 0.72； 95%置信区间[CI]分别为0.65 - 0.81和or = 0.80； 95% CI分别为0.72 - 0.87）。与医疗补助参保的患者相比，私人和医疗保险参保的患者更有可能进行住院泌尿外科手术（OR = 1.20； 95% CI分别为1.11 - 1.30和OR = 1.14； 95% CI分别为1.04 - 1.25）。结论：对于无并发症的肾绞痛患者，其处理存在与非临床因素相关的差异，即保险。目前还没有一致的指导方针来解决何时接纳或利用住院泌尿外科手术。(C) 2016 Elsevier Inc.版权所有。
Background: Renal colic results in > 1 million ED visits per year, yet there exists a gap in understanding how the majority of these visits, namely uncomplicated cases, are managed. Objective: We assessed patient-and hospital-level variation for emergency department (ED) management of uncomplicated kidney stones. Methods: We identified ED visits from non-elderly adults (aged 19-79 years) with a primary diagnosis indicating renal stone or colic from the 2011 Nationwide Emergency Department Sample. Patients with additional diagnostic codes indicating infection, sepsis, and abdominal aortic aneurysm were excluded. We used sample-weighted logistic regression to determine the association between hospital admission and having a urologic procedure with patient and hospital characteristics. Results: Of the 1,061,462 ED visits for uncomplicated kidney stones in 2011, 8.0% of visits resulted in admission and 6.3% resulted in an inpatient urologic procedure. Uninsured patients compared to Medicaid insured patients were less likely to be admitted or have an inpatient urologic procedure (odds ratio [OR] = 0.72; 95% confidence interval [CI] 0.65 - 0.81 and OR = 0.80; 95% CI 0.72 - 0.87, respectively). Private-and Medicare-insured patients compared to Medicaid-insured patients were more likely to have an inpatient urologic procedure (OR = 1.20; 95% CI 1.11 - 1.30 and OR = 1.14; 95% CI 1.04 - 1.25, respectively). Conclusions: For patients with uncomplicated renal colic, there is variation in the management associated with nonclinical factors, namely insurance. No consensus guidelines exist yet to address when to admit or utilize inpatient urologic procedures. (C) 2016 Elsevier Inc. All rights reserved.