Summary
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
Graphical AbstractGeneralized linear mixed models showing adjusted outcomes for primary (age cut-off = 18-years-old)
analyses of adults compared to pediatric patients within the PHIS database (2009–2020).
Keywords
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Article info
Publication history
Published online: July 14, 2022
Accepted:
July 10,
2022
Received in revised form:
June 6,
2022
Received:
February 15,
2022
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
