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Variation in care between pediatric and adult patients presenting with nephrolithiasis to tertiary care pediatric emergency departments in the United States (2009-2020).

Publication ,  Journal Article
Walton, RF; Yeh, C; Shannon, R; Rosoklija, I; Rague, JT; Johnson, EK; Alpern, ER; Ellison, JS; Routh, JC; Tasian, GE; Chu, DI
Published in: J Pediatr Urol
December 2022

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: Variations in care for individuals with nephrolithiasis reflect an opportunity for quality improvement in pediatric EDs and inform work exploring optimal care pathways for all patients presenting to the pediatric ED with nephrolithiasis.

Duke Scholars

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Published In

J Pediatr Urol

DOI

EISSN

1873-4898

Publication Date

December 2022

Volume

18

Issue

6

Start / End Page

742.e1 / 742.e11

Location

England

Related Subject Headings

  • Urology & Nephrology
  • United States
  • Tertiary Healthcare
  • Retrospective Studies
  • Kidney Calculi
  • Humans
  • Female
  • Emergency Service, Hospital
  • Chronic Disease
  • Child
 

Citation

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Walton, R. F., Yeh, C., Shannon, R., Rosoklija, I., Rague, J. T., Johnson, E. K., … Chu, D. I. (2022). Variation in care between pediatric and adult patients presenting with nephrolithiasis to tertiary care pediatric emergency departments in the United States (2009-2020). J Pediatr Urol, 18(6), 742.e1-742.e11. https://doi.org/10.1016/j.jpurol.2022.07.005
Walton, Ryan F., Chen Yeh, Rachel Shannon, Ilina Rosoklija, James T. Rague, Emilie K. Johnson, Elizabeth R. Alpern, et al. “Variation in care between pediatric and adult patients presenting with nephrolithiasis to tertiary care pediatric emergency departments in the United States (2009-2020).J Pediatr Urol 18, no. 6 (December 2022): 742.e1-742.e11. https://doi.org/10.1016/j.jpurol.2022.07.005.
Walton RF, Yeh C, Shannon R, Rosoklija I, Rague JT, Johnson EK, et al. Variation in care between pediatric and adult patients presenting with nephrolithiasis to tertiary care pediatric emergency departments in the United States (2009-2020). J Pediatr Urol. 2022 Dec;18(6):742.e1-742.e11.
Walton, Ryan F., et al. “Variation in care between pediatric and adult patients presenting with nephrolithiasis to tertiary care pediatric emergency departments in the United States (2009-2020).J Pediatr Urol, vol. 18, no. 6, Dec. 2022, pp. 742.e1-742.e11. Pubmed, doi:10.1016/j.jpurol.2022.07.005.
Walton RF, Yeh C, Shannon R, Rosoklija I, Rague JT, Johnson EK, Alpern ER, Ellison JS, Routh JC, Tasian GE, Chu DI. Variation in care between pediatric and adult patients presenting with nephrolithiasis to tertiary care pediatric emergency departments in the United States (2009-2020). J Pediatr Urol. 2022 Dec;18(6):742.e1-742.e11.
Journal cover image

Published In

J Pediatr Urol

DOI

EISSN

1873-4898

Publication Date

December 2022

Volume

18

Issue

6

Start / End Page

742.e1 / 742.e11

Location

England

Related Subject Headings

  • Urology & Nephrology
  • United States
  • Tertiary Healthcare
  • Retrospective Studies
  • Kidney Calculi
  • Humans
  • Female
  • Emergency Service, Hospital
  • Chronic Disease
  • Child