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Does a Multidisciplinary Pediatric Stone Center Improve Outcomes?
William DeFoor1, Eugene Minevich1, Elizabeth Jackson2
1Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Establishing a multidisciplinary pediatric stone center significantly reduced surgical procedures and emergency department visits for children with urolithiasis. This approach improves clinical outcomes for pediatric stone disease.
Area of Science:
- Pediatric Nephrology
- Pediatric Urology
- Public Health
Background:
- Urolithiasis (kidney stones) is increasingly common in children in the U.S.
- A dedicated multidisciplinary pediatric stone center was established in 2014 to manage this rising health concern.
- This study evaluates the center's development and patient outcomes.
Purpose of the Study:
- To assess the development and clinical outcomes of a multidisciplinary pediatric stone center.
- To determine the impact of the center on surgical procedures, emergency visits, and imaging.
Main Methods:
- Retrospective cohort study of pediatric patients (<21 years) with >6 months follow-up.
- Data collected included demographics, treatments, and clinical visits.
- Compared surgical procedures, emergency department visits, and CT scans before and after center enrollment.
Main Results:
- 264 pediatric patients met inclusion criteria; 60% had metabolic abnormalities.
- Surgical procedures decreased from 39% to 17% post-enrollment (p<0.0001).
- Emergency department visits dropped from 1.4 to 0.6 per year (p<0.0001); CT scan use decreased slightly (p=0.3).
Conclusions:
- A multidisciplinary pediatric stone center is a feasible model for coordinated care.
- Enrollment in the center led to significant reductions in surgical interventions and emergency visits for pediatric stone disease.
Introduction:
Urolithiasis is becoming more prevalent in children in the United States. A multidisciplinary pediatric stone center was initiated in 2014 to address this growing public health issue. The purpose of this manuscript is to assess the development of the stone center and its clinical outcomes.
Methods:
A retrospective cohort study was performed to assess clinical outcomes. Inclusion criteria included patients younger than 21 years of age with more than 6 months of followup. Data abstracted from the medical record included patient demographics, medications, imaging, metabolic evaluations, surgical procedures, and emergency department visits. The number of surgical procedures, emergency department visits, and computerized tomography scans were compared before and after the first visit to the stone center.
Results:
A total of 353 patients were evaluated in the stone center during the study period, 264 (98 male, 166 female) of whom met inclusion criteria. The mean age was 14.5 years, and the mean followup was 1.1 years. Of all patients 60% had a metabolic abnormality. Prior to the first visit 104 patients underwent surgery. Surgical procedures decreased from 39% to 17% during the year before and at any time after the first visit (p <0.0001). Emergency department visits per year decreased from 1.4 to 0.6 before and after the first visit (p <0.0001). Computerized tomography scan use decreased from 32% to 24% (p=0.3).
Conclusions:
A multidisciplinary stone center can be a feasible option to coordinate care and improve clinical outcomes. In our series the number of surgical procedures and emergency department visits decreased after enrollment.
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