title: Variation in the Intensity of Care for Patients with Uncomplicated Renal Colic Presenting to U.S. Emergency Departments.
abstract: BACKGROUND
  Renal colic results in > 1 million ED visits per year, yet there exists a gap in understanding how the majority of these visits, namely uncomplicated cases, are managed.
  
  
  OBJECTIVE
  We assessed patient- and hospital-level variation for emergency department (ED) management of uncomplicated kidney stones.
  
  
  METHODS
  We identified ED visits from non-elderly adults (aged 19-79 years) with a primary diagnosis indicating renal stone or colic from the 2011 Nationwide Emergency Department Sample. Patients with additional diagnostic codes indicating infection, sepsis, and abdominal aortic aneurysm were excluded. We used sample-weighted logistic regression to determine the association between hospital admission and having a urologic procedure with patient and hospital characteristics.
  
  
  RESULTS
  Of the 1,061,462 ED visits for uncomplicated kidney stones in 2011, 8.0% of visits resulted in admission and 6.3% resulted in an inpatient urologic procedure. Uninsured patients compared to Medicaid insured patients were less likely to be admitted or have an inpatient urologic procedure (odds ratio [OR] = 0.72; 95% confidence interval [CI] 0.65-0.81 and OR = 0.80; 95% CI 0.72-0.87, respectively). Private- and Medicare-insured patients compared to Medicaid-insured patients were more likely to have an inpatient urologic procedure (OR = 1.20; 95% CI 1.11-1.30 and OR = 1.14; 95% CI 1.04-1.25, respectively).
  
  
  CONCLUSIONS
  For patients with uncomplicated renal colic, there is variation in the management associated with nonclinical factors, namely insurance. No consensus guidelines exist yet to address when to admit or utilize inpatient urologic procedures.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut; Department of Internal Medicine, Yale-New Haven Hospital, New Haven, Connecticut; Department of Emergency Medicine, Yale-New Haven Hospital, New Haven, Connecticut.
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Elder
authors.affiliation: Department of Emergency Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: M Kit
authors.initials: MK
authors.lastname: Delgado
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, California.
authors.forename: Benjamin I
authors.initials: BI
authors.lastname: Chung
authors.affiliation: Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Pirrotta
authors.affiliation: Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: N Ewen
authors.initials: NE
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D007669:Kidney Calculi / Q000150:complications / Q000191:economics / Q000628:therapy*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D056844:Renal Colic / Q000191:economics / Q000209:etiology / Q000628:therapy*; D014481:United States; D013520:Urologic Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: HCUP; Healthcare Cost and Utilization Project; Medicaid; emergency departments; insurance; kidney stones; nephrolithiasis; renal colic; variation