Rising CT Use in Kidney Stone Diagnoses
Over 9 years, the use of computed tomography (CT) for diagnosing kidney stones in US emergency departments (EDs) rose from 73.8% in 2016 to 89.8% in 2024, according to a study published in The Journal of Emergency Medicine. This shift coincided with a decline in ultrasound use, which dropped from 5.8% to 3.8% during the same period.
Hospital admissions for nephrolithiasis increased from 8.9% to 12.7%, reflecting a trend toward inpatient care. The research, led by Grace V. Riley, MPH, at Rush University Medical College, analyzed 248,564,812 adult ED encounters between 2016 and 2024.
Methodology and Key Findings
The study utilized the Epic Cosmos database, which aggregates electronic health records from over 42,000 US hospitals and clinics. Researchers evaluated imaging practices, medication prescriptions, and procedural interventions for patients with and without nephrolithiasis.
Key metrics included an increase in urine culture collection and a rise in tamsulosin prescriptions, the most commonly used discharge medication. However, the study noted limitations, such as potential overrepresentation of CT imaging due to diagnostic code reliance.
Shift in Treatment Approaches
Authors highlighted a “substantial increase in CT utilization relative to general ED trends” and a move away from opioid-based pain management. Non-opioid analgesics gained prominence.
“Understanding these contemporary practice patterns can help guide quality improvement initiatives for diagnostic imaging and disposition decisions in the ED,” the study stated. The findings show that imaging is increasingly used to manage nephrolithiasis.
Diagnostic codes and observational design limit study conclusions
The study’s reliance on diagnostic codes may have skewed results, as some imaging could have been performed for unrelated conditions. Factors like pre-ED medication use and urologic consultation rates were not assessed.
Researchers emphasized that observational design limits causal conclusions. However, the data provides a snapshot of evolving ED practices.
Why CT use for kidney stones increased?
Why has CT use for kidney stones increased?
The study identifies a shift toward greater CT use and inpatient management for the diagnosis of kidney stones in US emergency departments.
What are the risks of over-reliance on CT imaging?
The study noted that ultrasound use saw declining use from 5.8% to 3.8% as CT use increased.
How do treatment trends reflect broader medical shifts?
The shift toward non-opioid pain management and increased inpatient admissions highlight evolving management of kidney stone cases in emergency departments.
Hospital admissions for nephrolithiasis continue to rise
Pro Tip: Nephrolithiasis is a prevalent and growing cause of emergency department visits, with an ongoing increase in hospital admissions over time.
Source Insights
The study’s authors, including Grace V. Riley, emphasize that grasping these current practice patterns can aid in shaping quality improvement efforts for diagnostic imaging and patient disposition decisions in the ED.
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