Predictors of Hospital Admission and Urological Intervention in Adult Emergency Department Patients with Computerized Tomography Confirmed Ureteral Stones.
Predictors of Hospital Admission and Urological Intervention in Adult Emergency Department Patients with Computerized Tomography Confirmed Ureteral Stones.
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DOI：
10.1016/j.juro.2017.06.077
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发表时间：
2017-12
期刊：
影响因子：
--
通讯作者：
Moore CL
中科院分区：
文献类型：
--
作者：
Daniels B;Schoenfeld E;Taylor A;Weisenthal K;Singh D;Moore CL
每年有超过一百万的肾结石患者在急诊科（ED）寻求治疗，但少数患者需要住院或泌尿外科手术。我们的目的是描述住院或泌尿系统干预的预测因素。这项前瞻性数据的二次分析包括了经ct证实的输尿管梗阻性结石的ED患者。所有患者还接受了定点有限肾脏超声检查（PLUS）。通过随访访谈评估90天泌尿系统干预的必要性。采用Logistic回归来确定住院和泌尿外科干预的预测因素，并进一步按性格分层。使用c统计量比较有和没有CT表现的单独回归模型（仅PLUS）。在475例CT显示有症状性结石的患者中，95例（20%）入院，68例（72%）接受了干预。380例出院患者中，66例（17%）需要泌尿外科干预。入院的患者更有可能有过先前的手术，有肾脏损伤或感染的证据，需要阿片类止痛药，有较大的结石或肾积水。干预的预测因素因性格而异，尽管有和没有CT结果的回归模型显示了相似的c统计。结石较大、就诊时疼痛持续时间较长、既往手术的出院患者更有可能接受干预。干预在住院患者中很常见，但在少数出院患者中也有。干预的预测因素因性格而异，纳入CT结果的模型与未纳入CT结果的模型相似。这些数据支持超声优先或延迟ct诊断路径对临床认为适合出院的患者。
Over one million patients seek care in an Emergency Department (ED) for kidney stones annually, but a minority require admission or urologic procedure. We aim to describe predictors of hospital admission or urologic intervention. This secondary analysis of prospective data includes ED patients with CT-confirmed obstructing ureteral stone. All patients also received a point-of-care limited renal ultrasound (PLUS). Need for urologic intervention at 90 days was assessed by follow-up interview. Logistic regression was used to identify predictors of admission and urologic intervention, which were further stratified by disposition. Separate regression models with and without CT findings (PLUS only) were compared using the c-statistic. Among a cohort of 475 patients with symptomatic stone on CT, 95 (20%) were admitted and 68 had an intervention (72%). Of 380 discharged patients, 66 (17%) required urologic intervention. Admitted patients were more likely to have had a prior procedure, evidence of kidney injury or infection, need opiate analgesia, have larger stones or hydronephrosis on PLUS. Predictors of intervention varied by disposition, though regression models with and without CT findings demonstrated similar c-statistics. Discharged patients with larger stones, a longer duration of pain at presentation, and prior procedures were more likely to undergo intervention. Intervention was common among admitted patients but occurred in a minority of those discharged. Predictors of intervention varied by disposition and models incorporating CT findings were similar to those without. These data support ultrasound-first or delayed-CT diagnostic pathways for patients deemed clinically suitable for discharge.
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影响因子：
5
作者：
Coll, DM;Varanelli, MJ;Smith, RC
通讯作者：
Smith, RC
DOI：
10.1136/bmj.g2191
发表时间：
2014-03-26
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Moore CL;Bomann S;Daniels B;Luty S;Molinaro A;Singh D;Gross CP
通讯作者：
Gross CP
影响因子：
1.7
作者：
Dean, Tanya;Crozier, Jack;Kelly, Anne-Maree
通讯作者：
Kelly, Anne-Maree
影响因子：
6.6
作者：
Blackwell, Robert H.;Barton, Gregory J.;Gupta, Gopal N.
通讯作者：
Gupta, Gopal N.
影响因子：
1.5
作者：
Elder, Joshua W.;Delgado, M. Kit;Wang, N. Ewen
通讯作者：
Wang, N. Ewen