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Imaging trends and surgical outcomes for nephrolithiasis in the pediatric emergency department
Vidya R Raghavan1, John J Porter1, Michael C Monuteaux1
1Division of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America.
Insights
Pediatric nephrolithiasis diagnosis using computed tomography (CT) varies widely. This study found no link between hospital CT use and surgery rates for pediatric kidney stones, suggesting opportunities to reduce radiation exposure.
Area of Science:
- Pediatric Nephrology
- Medical Imaging
- Health Services Research
Background:
- Pediatric nephrolithiasis incidence has increased significantly over the last two decades.
- Computed tomography (CT) is the standard for diagnosing kidney stones but involves ionizing radiation exposure.
- Minimizing radiation in children is a critical public health concern.
Purpose of the Study:
- To analyze imaging trends and surgical intervention rates for pediatric nephrolithiasis.
- To investigate the association between hospital-level CT utilization and surgical intervention rates.
- To identify potential areas for reducing CT use in pediatric kidney stone management.
Main Methods:
- Multicenter, cross-sectional analysis of the Pediatric Health Information System (2010-2021).
- Inclusion of children diagnosed with nephrolithiasis in the emergency department (ED).
- Logistic regression to assess the relationship between hospital CT utilization quartiles and surgery rates, controlling for patient demographics and treatments.
Main Results:
- Analysis of 15,979 ED visits across 29 hospitals revealed substantial variation in CT use (13-91%).
- Surgery rates at index visit (5.3-7.5%) and within 6 months (15.1-19.1%) showed no significant difference across CT utilization quartiles.
- Adjusted analysis found no significant association between hospital CT utilization and surgery rates during the index hospitalization or within 180 days (p-trend = 0.19 and 0.26).
Conclusions:
- No significant association was found between hospital-level CT utilization and surgical intervention rates for pediatric nephrolithiasis.
- Findings suggest that CT use can potentially be reduced in children presenting with kidney stones.
- Opportunities exist to optimize imaging strategies and minimize radiation exposure in this population.
Objectives:
There has been a marked rise in the incidence of pediatric nephrolithiasis over the past two decades. Although computed tomography (CT) is the gold standard for the diagnosis of nephrolithiasis, efforts to reduce minimize childhood exposure to ionizing radiation remain important. This study aims to assess current imaging trends and rates of surgical intervention for nephrolithiasis at the hospital level.
Methods:
A multicenter, cross-sectional analysis was conducted using the Pediatric Health Information System, which included children treated in the emergency department (ED) and diagnosed with nephrolithiasis using ICD 9/10 codes from 2010 to 2021. The analysis involved a hospital-level examination where hospitals were grouped into quartiles based on their rates of CT use. Logistic regression was employed to evaluate the association between hospital-level CT utilization and rates of surgery, while accounting for demographic characteristics and treatments administered including opioids, intravenous fluids, and antibiotics.
Results:
We analyzed 15,979 ED visits (median age 15 years, 59 % female) across 29 hospitals. There was significant variation in CT utilizations across hospitals (range 13-91 %). Surgery rates at the index visit ranged from 5.3 to 7.5 % and rates of surgery within 6 months ranged from 15.1 to 19.1 % across hospital CT quartiles. After adjusting for demographic characteristics and treatment administered, odds of surgery occurring during the index hospitalization or within 180 days did not differ based upon hospital-level CT utilization (p-trend = 0.19 and 0.26, respectively).
Conclusions:
In this hospital-level study of imaging and surgical intervention for pediatric nephrolithiasis, we found no significant association between CT utilization and rates of surgery either during the index visit or within 180 days of the ED visit. These findings suggest there are opportunities to further reduce CT usage in children presenting with nephrolithiasis.
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