Presentation Authors: John Fisher*, Matthew Sorensen, KNOXVILLE, TN, Michael Jennings, 37919, TN, Jerry Edwards, James Bienvenu, Knoxville, TN
Introduction: The American College of Emergency Physicians (ACEP) conducts E-QUAL studies to determine means of cost reduction and improved outcomes in patients on initial hospital evaluation. CT scan remains the gold standard for diagnosing nephrolithiasis. In certain patients, treatment could be initiated with renal ultrasound and KUB x-ray to reduce radiation, cost, and the sheer quantity of patients undergoing CT scan through the ER. This study defines an algorithm for ER patient selection to have preferential ultrasound and plain X-ray.
Methods: Over 300 institutions participated in Wave III of the Avoidable Imaging Initiative and of these 5 chose CT stone study for quality assessment. The study objective would be assessing the trend in number of patients with stones diagnosed on CT over total studies ordered for flank pain/back pain with history of nephrolithiasis. These numbers were compared to other institutions. Variables established for renal ultrasound/KUB were creatinine < 1.2, WBC < 13,000, Temperature < 100 degrees Fahrenheit, Urinalysis without nitrite or large bacteria, SIRS criteria or persistent tachycardia.
Results: Over Q1, the baseline rate of identification of stones in patients suspected of renal colic was 13%. The range from all emergency departments participating in the study was 9%-52%. There were a total number of ED discharges for back or flank pain of 660 and of these 87 received CT stone study. The results for Q3 are presently in progress to determine if the intervention of these metrics affects overall CT rate in patients with a constellation of stone symptoms.
Conclusions: This preliminary data suggests there could be merit to introducing changes at the ER level to reduce overutilization of CT scan for stone patients with recurring nephrolithiasis. By identifying a scenario indicating a need for surgery, CT can be avoided in exchange for intraoperative fluoroscopy in select patients or medical expulsive therapy in known stone formers.