Endourology and StonesTrends in Medical Expulsive Therapy Use for Urinary Stone Disease in U.S. Emergency Departments
Section snippets
Material and Methods
Data were analyzed from the National Hospital Ambulatory Medical Care Survey (NHAMCS). Designed by the National Center for Health Statistics and administered by the US Census Bureau, the NHAMCS is an annual 4-stage probability sample of outpatient or ED visits to randomly selected, nonfederal short-stay hospitals in the U.S. All aspects of each visit are weighted, and the weights are adjusted to account for nonresponse and nonparticipation, allowing for extrapolation to the universe of
Results
The frequency of ED visits for urinary stone disease was stable over the study period, ranging from 3.2 visits (95% confidence interval (CI), 2.5-3.8) per 1000 US population in 2006 to 4.2 visits (95% CI, 3.3-5.1) per 1000 US population in 2004. Mean age was comparable between patients who were treated with MET and those who were not (41.0 vs 41.4 years, respectively). Although 39.6% of eligible visits were made by women, they accounted for only 21% of the encounters at which MET was
Comment
Despite the growing body of evidence to support its safety and efficacy for promoting upper tract stone passage,10, 11 our analysis reveals the sluggish dissemination of MET into the broader medical community. The exceedingly low prevalence of use (prescribed at only 1.1% of eligible ED visits during the 7-year study period) implies a missed opportunity to spare approximately 260 000 individuals annually from surgery and its risks. Taken together, the observed underuse of MET represents a block
Conclusions
Despite the growing body of evidence to support its safety and efficacy, our analysis reveals the sluggish dissemination of MET into the broader medical community. Given the low cost of MET ($28) and the expense of stone procedures ($4773 for ureteroscopy),20 these observed trends likely have significant economic implications for the US health care system. Further, this underuse represents a block in the translation of clinical science into practice and raises a quality of care concern.
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Cited by (22)
Medical Management of Renal and Ureteral Stones
2022, Comprehensive PharmacologyUse of medical expulsive therapy in children: An assessment of nationwide practice patterns and outcomes
2017, Journal of Pediatric UrologyMedical expulsive therapy use in emergency department patients diagnosed with ureteral stones
2017, American Journal of Emergency MedicineEffect of Tamsulosin on Stone Passage for Ureteral Stones: A Systematic Review and Meta-analysis
2017, Annals of Emergency MedicineCitation Excerpt :It is estimated there are now more than 2 million annual outpatient visits for urolithiasis in the United States.11 Although urologists have been proponents of α-blocker use, other clinicians who manage urolithiasis have used α-blockers at low rates.11,12 A clear understanding of the value of tamsulosin would help clinicians to decide whether to offer this therapy to patients with a common, recurrent, painful, and costly problem.
Editorial Comment
2015, Urology
Supported by: PhRMA Foundation Research Starter Grant (to B. K. H.).