title: Is the Economic Impact and Utilization of Imaging Studies for Pediatric Urolithiasis Across the United States Increasing?
abstract: OBJECTIVE
  To identify longitudinal trends of economic impact and resource utilization for management of pediatric urolithiasis using national databases.
  
  
  METHODS
  We analyzed the 2006-2012 Nationwide Emergency Department Sample and Nationwide Inpatient Sample. We used ICD-9 (International Classification of Diseases) codes to identify patients (≤18 years) diagnosed with urolithiasis. Diagnostic imaging and surgeries were identified using ICD-9 and Current Procedural Technology codes. We abstracted demographic, imaging, procedure, and charge data. Weighted descriptive statistics were calculated to describe the population's demographics and economic expenditures by clinical setting and year.
  
  
  RESULTS
  In total, 45,333 inpatient admissions (68% females) and 234,559 emergency department encounters (63% females) were identified. Most patients (84%) were teenagers and the southern region of the United States was the most common geographic region for all encounters (44%). There was no significant trend in number of urolithiasis encounters over the period studied. Utilization of all imaging techniques increased; in particular, computed tomography was used in 23% of encounters in 2006 and 40% in 2012 (P < .0001). The mean charge per emergency department visit increased by 60% from $3645 in 2006 to $5827 in 2012 (P < .0001). The mean charge increased for inpatient admissions by 102%, from $16,399 in 2006 to $33,205 in 2012 (P < .0001). Total charges increased 72% over the study period from $230 million in 2006 to $395 million in 2012 (P < .0001), outpacing medical inflation over the same period.
  
  
  CONCLUSIONS
  Charges for pediatric urolithiasis management increased by 65% from 2006 to 2012 despite stable frequency of patient encounters. The utilization of computerized tomography in pediatric urolithiasis increased as well.
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Young
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Rohit
authors.initials: R
authors.lastname: Tejwani
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Hsin-Hsiao S
authors.initials: HH
authors.lastname: Wang
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University, Durham, NC.
authors.forename: Steven
authors.initials: S
authors.lastname: Wolf
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: J Todd
authors.initials: JT
authors.lastname: Purves
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: John S
authors.initials: JS
authors.lastname: Wiener
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, NC. Electronic address: jonathan.routh@duke.edu.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Routh
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D014481:United States; D052878:Urolithiasis / Q000000981:diagnostic imaging* / Q000191:economics*