Emergency room management of ureteral calculi: current practices.
OBJECTIVE
To evaluate current practice patterns in U.S. emergency departments (EDs) for the diagnosis, treatment, and counseling of patients with ureteral calculi.


METHODS
Hospital-based ED physicians were invited by e-mail to participate in a Survey-Monkey survey. E-mails were delivered in March 2008 by Direct Medical Data using a listserv provided by the American Medical Association. Of the e-mails sent, 173 e-mails were opened, and 135 physicians responded. Physicians were compensated with a $10 Amazon.com gift card.


RESULTS
Ninety percent of ED physicians use noncontrast CT as their initial imaging modality, and 63% use alpha-blockers for medical expulsive therapy. Only 13% of evaluated EDs have guidelines for the management of renal colic, and only 58% of these guidelines that recommend the use of an alpha-blocker. Alpha-blocker use was more common with physicians who have been practicing fewer than 5 years (81%) compared with those with more than 10 years of experience (56%). The majority of physicians used ketorolac and morphine to achieve effective analgesia. Although the average responses concerning the chance of spontaneous stone passage for stones <or=4 mm (87%) and >4 mm (44%) were close to evidence-based values, great variation in the answers was noted (standard deviations: 12% and 22%, respectively). Indeed, 38% of respondents stated that stones <or=4 mm had a >95% chance of passage. Twenty-eight percent of ED physicians would arrange follow-up with a primary care physician, while the remainder would arrange follow-up with a urologist.


CONCLUSIONS
This study establishes a need for educational opportunities for ED physicians in the management of renal colic. The development of collaborative practice guidelines between urology and emergency medicine associations may be warranted.
Phillips
Elizabeth
E
Department of Urology, University of Minnesota, Minneapolis, MN 55455, USA.
Kieley
Sam
S
Johnson
Elizabeth B
EB
Monga
Manoj
M
D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D003085:Colic / Q000628:therapy; D004636:Emergency Service, Hospital / Q000639:trends*; D005440:Fluid Therapy; D006801:Humans; D014514:Ureteral Calculi / Q000188:drug therapy / Q000628:therapy*
D000317:Adrenergic alpha-Antagonists