title: Medical expulsive therapy use in emergency department patients diagnosed with ureteral stones.
abstract: OBJECTIVE
  Recent studies have clarified the role of alpha-blockers, such as tamsulosin, for patients diagnosed with ureteral stones <10mm not requiring an urgent intervention. Prior studies have reported low rates of use of MET by emergency physicians. We sought to describe patterns of alpha-blocker use and to determine factors associated with utilization in patients diagnosed with ureterolithiasis in the ED.
  
  
  METHODS
  We used data from a randomized trial of CT scan vs. ultrasound in participants with suspected urolithiasis enrolled at 15 EDs between October 2011 and February 2013. The use of medical expulsive therapy was identified by the prescription of an alpha-blocker, calcium channel blocker, or steroid at the ED visit. The prevalence of alpha-blocker use in participants with ureteral stones on imaging was calculated, and multivariable models were used to examine risk factors for utilization.
  
  
  RESULTS
  Of the 524 participants who were identified with a ureteral stone on CT scan and discharged from the ED, 375 (71.4%) received an alpha-blocker, and 2 (<1%) received a steroid. There was no significant difference in alpha-blocker use for participants based on stone size or location. However, there was a 3.6-fold difference in alpha-blocker use between the lowest and highest use ED sites. In the multivariable analysis, ED site was independently associated with utilization of alpha-blockers.
  
  
  CONCLUSIONS
  Alpha-blockers were prescribed in more than two-thirds of patients with a distal ureteral stone on imaging, a much higher prevalence than previously reported. There was substantial variability in alpha-blocker use based on ED site.
authors.affiliation: Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA. Electronic address: ralph.wang@ucsf.edu.
authors.forename: Ralph C
authors.initials: RC
authors.lastname: Wang
authors.affiliation: Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Newton
authors.initials: N
authors.lastname: Addo
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Chi
authors.affiliation: Department of Emergency Medicine, Yale University, New Haven, CT, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Moore
authors.affiliation: Division of Emergency Medicine, University of Utah, Salt Lake City, UT, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Mallin
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Shiboski
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Marshall
authors.initials: M
authors.lastname: Stoller
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Smith-Bindman
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000627:therapeutic use*; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D013449:Sulfonamides / Q000627:therapeutic use*; D000077409:Tamsulosin; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States; D052878:Urolithiasis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D000700:Analgesics; D002121:Calcium Channel Blockers; D013449:Sulfonamides; D000077409:Tamsulosin