Emergency department utilization patterns for pediatric urinary stone patients in the United States

The prevalence of pediatric urolithiasis has increased rapidly, leading to more emergency department (ED) visits across the United States.

The purpose of this study was to determine emergency care practices for children and adolescents with urinary stones and characteristics associated with management.

We performed a cross-sectional study of the 2021 Nationwide Emergency Department Sample to identify pediatric patients (≤21 years) presenting to an ED in the United States with a primary diagnosis of urinary stone disease. The primary outcome was patient disposition. Multivariable logistic regression was used to identify patient and hospital characteristics associated with hospital admission. Imaging utilization was a secondary outcome of the study.

There were 57 pediatric ED visits for urinary stone disease per 100,000 population in the study (mean age 17.7 years; 59.6 % female). Most patients (91.2 %) were treated and discharged, while 6.9 % were admitted to the same hospital. Computed tomography was the primary imaging modality (60.2 %), with utilization increasing with age. Considerable variability in disposition and imaging utilization was observed, with hospital admission rates ranging from 1.3 % to 55.1 % and CT use from 1.7 % to 77.5 % among patient and hospital subgroups.

This study reveals a high rate of pediatric urinary stone presentations to United States EDs. Significant variations in disposition and imaging utilization across different patient and hospital characteristics highlight the need for standardized, evidence-based approaches to pediatric urinary stone care.