Summary
Introduction
Early data support the use of medical expulsive therapy (MET) in children. However,
little is known regarding use or outcomes associated with MET outside of pediatric-specific
practices. Using a national administrative dataset, we sought to characterize utilization
patterns of MET as well as assess outcomes associated with MET exposure.
Study design
We interrogated the MarketScan Commercial Claims and Encounters database to identify
children under the age of 18 presenting to the emergency department (ED) with any
diagnosis of upper urinary tract calculi (UUTC, including renal and ureteral calculi).
MET exposure was defined as having a prescription filled for a MET agent within 1
week of the ED encounter. Characteristics of children receiving MET were defined and
outcomes compared between children with and without MET exposure.
Results
Of 1325 children included in the study, 13.2% received MET, including 15.4% of children
with a diagnosis of “calculus of the ureter.” MET use increased significantly throughout
the study period (p = 0.004), although only 30.4% of children considered potential MET candidates received
MET in the final year of the study (2013). Among all patients, receipt of MET was
associated with male gender, presence of comorbidity, provider-type (urologist), and
year of diagnosis, although among those with a specific diagnosis of “calculus of
the ureter,” only year of diagnosis remained a significant factor. Rates of unplanned
physician visits and surgical interventions were similar between groups. Children
receiving MET were more likely to receive follow-up imaging, although only 46% of
children with ureteral calculi had appropriate follow-up imaging within 90 days, regardless
of MET exposure. Odds ratios of factors and outcomes associated with MET exposure
are shown in the Table.
Discussion
Although early data support safety and efficacy MET in children, nationwide use in
children is low among potential candidates for MET. For children with ureteral calculi,
only year of diagnosis was a significant factor associated with MET use. No difference
in unplanned physician visits or surgical interventions was noted. Most notable, however,
was the low rate of follow-up imaging within 90 days for children presenting acutely
with UUTC.
Conclusions
Use of MET for children with ureteral calculi is increasing, although still fewer
than a third of children considered potential candidates receive this treatment. Follow-up
imaging is not obtained for many children with ureteral calculi. Future work is needed
to standardize management and follow-up protocols for children with acute renal colic.
TableOR and CI for factors associated with use of MET.
| Demographic | Whole group (n = 1325) | Calculus of the ureter (n = 527) |
|---|---|---|
| OR (95% CI) | OR (95% CI) | |
| Factors associated with receipt of MET | ||
| Age | 1.05 (1.00–1.10) | 1.02 (0.95–1.10) |
| Female | 0.64 (0.46–0.90) | 0.77 (0.47–1.28) |
| Urologist provider | 2.04 (1.32–3.15) | 1.60 (0.88–2.90) |
| Year of diagnosis | 1.31 (1.19–1.44) | 1.34 (1.15–1.56) |
| Outcomes associated with receipt of MET | ||
| ED visit | 0.63 (0.34–1.19) | 1.36 (0.59–3.12) |
| Hospital admission | 0.94 (0.59–1.48) | 1.28 (0.64–2.56) |
| Appropriate imaging | 1.67 (1.21–2.32) | 1.69 (1.03–2.77) |
| Surgical intervention | 1.11 (0.77–1.60) | 0.96 (0.57–1.63) |
Top of table shows factors associated with initial MET exposure. Bottom of table shows
90-day outcomes associated with MET exposure at initial visit.
Keywords
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Article info
Publication history
Published online: April 20, 2017
Accepted:
March 14,
2017
Received:
November 18,
2016
Identification
Copyright
© 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
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- Commentary to ‘Utilization of medical expulsive therapy in children: An assessment of nationwide practice patterns and outcomes’Journal of Pediatric UrologyVol. 13Issue 5
- PreviewNational databases are valuable tools with which to evaluate treatment outcomes while accounting for patient-related and healthcare-related barriers, and allowing a view of treatment patterns from 10,000 feet. Critical steps in utilizing databases, however, include accurate data entry and analysis. Consequently, if study results are not carefully interpreted, databases are at risk of transforming into ‘databiases’.
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