ABSTRACT
OBJECTIVE: To investigate the impact of climate and seasonal variations on emergency department (ED) admissions for renal colic, while specifically comparing the differences between individuals with sedentary and non-sedentary lifestyles. PATIENTS AND METHODS: A retrospective, single center study was conducted. Between the years 2017- 2020, medical records of patients admitted to the ED with renal colic, found to harbor ureteric stones on CT scans, were examined. Data on patients' occupational activities was collected through telephone questionnaires. Patients were categorized into two groups: sedentary and active. Precise weather data was obtained from the Israeli Meteorological Service website. The monthly average daily maximum temperatures were calculated. RESULTS: In the final sample of 560 participants, 285 were in the sedentary group, and 275 were in the active group. The study population consisted of 78.1% males and 21.9% females, with consistent gender ratios in both occupational groups. Prevalence of uric acid stones was higher in the sedentary group (p < 0.05). While there was a slight increase in admissions during the summer, seasonal distribution did not significantly differ among occupational groups. The study found no significant differences in admissions across different temperature ranges. Both groups exhibited a pattern of increased referrals during the summer and reduced referrals in the colder winter months. The baseline data revealed notable differences between the sedentary and active groups, particularly in the prevalence of uric acid stones. CONCLUSIONS: Climate factors, including temperature and seasonal variations, had limited impact on ED admissions for renal colic in patients with kidney stones, irrespective of their sedentary or active lifestyles. Both groups exhibited similar admission patterns, with a higher rate of admissions during the summer and a lower rate of admissions during the winter.
Subject(s)
Climate , Emergency Service, Hospital , Renal Colic , Sedentary Behavior , Humans , Renal Colic/epidemiology , Male , Female , Retrospective Studies , Emergency Service, Hospital/statistics & numerical data , Adult , Middle Aged , Seasons , Patient Admission/statistics & numerical data , Hospitalization/statistics & numerical data , Israel/epidemiologyABSTRACT
OBJECTIVE: The impact of Ramadan fasting on the prevalence of renal colic (RC) remains controversial. This current study aimed to assess the correlation between Ramadan fasting, prevalence of RC and the rate of urgent endoscopic interventions due to urolithiasis. METHODS: This retrospective case-control study enrolled adult patients with a primary diagnosis of RC secondary to urolithiasis admitted to the emergency department during the years 2009-2019. The prevalence of RC and the rate of urgent urological interventions during Ramadan were compared with the pre- and post-Ramadan months in fasting Muslims and non-fasting non-Muslim patients. RESULTS: A total of 2781 patients with RC were included: 1014 (36.5%) were fasting Muslim and 1767 (63.5%) were non-fasting non-Muslim patients. No significant increase in RC admissions or urgent double J stent (DJS) insertions were observed between pre-Ramadan and Ramadan among fasting Muslims and non-fasting non-Muslim patients. However, fasting Muslims exhibited a significant increase of RC admissions post-Ramadan compared with Ramadan. CONCLUSIONS: There was no correlation between increased RC admissions or urgent DJS insertions when fasting Muslims were compared with non-fasting non-Muslim patients during Ramadan. There were increased RC admissions during the post-Ramadan month, which might indicate a delayed effect of fasting on RC.
Subject(s)
Fasting , Islam , Renal Colic , Urolithiasis , Humans , Male , Female , Retrospective Studies , Middle Aged , Renal Colic/epidemiology , Renal Colic/etiology , Urolithiasis/epidemiology , Case-Control Studies , Adult , Prevalence , Aged , Emergency Service, Hospital/statistics & numerical data , Hospitalization/statistics & numerical dataABSTRACT
Urolithiasis has a seasonal pattern, with an established increase in incidence during the summer months. This study aims to assess the impact of high ambient temperatures on emergency room (ER) visits related to renal colic (RC) in a Middle Eastern country over the past decade. Population data were extracted using the MDClone Big Data platform. We recorded demographic and clinical data on all RC-associated ER visits from January 2012 to April 2023 and calculated the heat index (HI) that combines daily average coastal plane temperatures and humidity percentages. There was a total of 12,770 ER visits (median age 48 years, 9,236 (72%) males). The number of visits increased during the hottest months (July-October), with the highest numbers recorded during August. The number of visits remained stable throughout the study. We identified a linear association between humidity and the incidence of ER visits (p = 0.002), and a non-linear association between ambient temperature (p < 0.0001) and HI (p < 0.0001). There was a direct relationship between high temperatures and ER visits on the same day (risk ratio [RR]: 1.75, p = 0.036), with a 2-day lag (RR: 1.123, p = 0.024). In Conclusion, there is a significant relationship between temperature, humidity, HI, and the number of ER visits due to RC. Adjusted resource allocation and healthcare workforce availability are essential for managing additional cases during heat waves. Clinical implications: Increased demand is expected during heatwaves and within a 2-day lag, emphasizing the importance of proactive strategies to effectively manage RC patients.
Subject(s)
Renal Colic , Urolithiasis , Male , Humans , Middle Aged , Female , Renal Colic/epidemiology , Renal Colic/etiology , Renal Colic/therapy , Temperature , Middle East/epidemiology , Emergency Service, HospitalABSTRACT
BACKGROUND: Pediatric urolithiasis is relatively uncommon and is generally associated with predisposing anatomic or metabolic abnormalities. In the adult population, emergency department (ED) admissions have been associated with an increase in ambient temperature. The same association has not been evaluated in the pediatric population. OBJECTIVES: To analyze trends in ED admissions due to renal colic in a pediatric population (≤ 18 years old) and to assess the possible effect of climate on ED admissions. METHODS: We conducted a retrospective, multicenter cohort study, based on a computerized database of all ED visits due to renal colic in pediatric patients. The study cohort presented with urolithiasis on imaging during their ED admission. Exact climate data was acquired through the Israeli Meteorological Service (IMS). RESULTS: Between January 2010 and December 2020, 609 patients, ≤ 18 years, were admitted to EDs in five medical centers with renal colic: 318 males (52%), 291 females (48%). The median age was 17 years (IQR 9-16). ED visits oscillated through the years, peaking in 2012 and 2018. A 6% downward trend in ED admissions was noted between 2010 and 2020. The number of ED admissions in the different seasons was 179 in autumn (30%), 134 in winter (22%), 152 in spring (25%), and 144 in summer (23%) (P = 0.8). Logistic regression multivariable analysis associated with ED visits did not find any correlation between climate parameters and ED admissions due to renal colic in the pediatric population. CONCLUSIONS: ED admissions oscillated during the period investigated and had a downward trend. Unlike in the adult population, rates of renal colic ED admissions in the pediatric population were not affected by seasonal changes or rise in maximum ambient temperature.
Subject(s)
Renal Colic , Urolithiasis , Adolescent , Child , Female , Humans , Male , Cohort Studies , Emergency Service, Hospital , Renal Colic/epidemiology , Renal Colic/etiology , Retrospective StudiesABSTRACT
Objective: To determine the incidence of and risk factors for imaging in patients presenting to the emergency department (ED) with renal colic. Subject/Patients and Methods: We conducted a population-based cohort study in the province of Ontario, utilizing linked administrative health data. Patients who presented to an ED with renal colic between April 1, 2010, and June 30, 2020, were included. The rate of initial imaging (CT scans and ultrasound [U/S]) and repeat imaging within 30 days was determined. Generalized linear models were utilized to evaluate patient and institutional-level characteristics associated with imaging, and specifically CT vs U/S. Results: There were 397,491 index renal colic events, of which 67% underwent imaging (CT 68%, U/S 27%, and CT+U/S same day 5%). Repeat imaging was performed in 21% of events (U/S in 12.5%, CT in 8.4%) at a median of 10 days. Of those with an initial U/S, 28% had repeat imaging compared with 18.5% for those with an initial CT. Undergoing an initial CT was associated with being male, urban residence, later year of cohort entry, history of diabetes mellitus and inflammatory bowel disease, and presentation to nonacademic hospitals of larger size, or with a higher volume of ED visits. Conclusion: Two-thirds of renal colic patients underwent imaging, and CT was the most utilized modality. Patients undergoing an initial CT had a lower likelihood of repeat imaging within 30 days. The utilization of CT increased over time and was more common in males and those presenting to nonacademic hospitals of larger size, or with higher ED volumes. Our study highlights the patient- and institution-level factors that need to be targeted with prevention strategies to reduce the utilization of CT scans, when possible, for cost reduction and to minimize patient exposure to ionizing radiation.
Subject(s)
Colic , Renal Colic , Humans , Male , Female , Renal Colic/diagnostic imaging , Renal Colic/epidemiology , Renal Colic/etiology , Cohort Studies , Incidence , Emergency Service, Hospital , Risk FactorsABSTRACT
OBJECTIVE: To evaluate whether patients discharged to home after an emergency department (ED) visit for headache face a heightened short-term risk of stroke. BACKGROUND: Stroke hospitalizations that occur soon after ED visits for headache complaints may reflect diagnostic error. METHODS: We conducted a retrospective cohort study using statewide administrative claims data for all ED visits and admissions at nonfederal hospitals in Florida 2005-2018 and New York 2005-2016. Using standard International Classification of Diseases (ICD) codes, we identified adult patients discharged to home from the ED (treat-and-release visit) with a benign headache diagnosis (cohort of interest) as well as those with a diagnosis of renal colic or back pain (negative controls). The primary study outcome was hospitalization within 30 days for stroke (ischemic or hemorrhagic) defined using validated ICD codes. We assess the relationship between index ED visit discharge diagnosis and stroke hospitalization adjusting for patient demographics and vascular comorbidities. RESULTS: We identified 1,502,831 patients with an ED treat-and-release headache visit; mean age was 41 (standard deviation: 17) years and 1,044,520 (70%) were female. A total of 2150 (0.14%) patients with headache were hospitalized for stroke within 30 days. In adjusted analysis, stroke risk was higher after headache compared to renal colic (hazard ratio [HR]: 2.69; 95% confidence interval [CI]: 2.29-3.16) or back pain (HR: 4.0; 95% CI: 3.74-4.3). In the subgroup of 26,714 (1.78%) patients with headache who received brain magnetic resonance imaging at index ED visit, stroke risk was only slightly elevated compared to renal colic (HR: 1.47; 95% CI: 1.22-1.78) or back pain (HR: 1.49; 95% CI: 1.24-1.80). CONCLUSION: Approximately 1 in 700 patients discharged to home from the ED with a headache diagnosis had a stroke in the following month. Stroke risk was three to four times higher after an ED visit for headache compared to renal colic or back pain.
Subject(s)
Renal Colic , Stroke , Adult , Humans , Female , Male , Renal Colic/diagnosis , Renal Colic/epidemiology , Renal Colic/therapy , Retrospective Studies , Emergency Service, Hospital , Hospitalization , Headache/diagnosis , Headache/epidemiology , Headache/therapy , Back Pain , Stroke/epidemiology , Stroke/therapyABSTRACT
PURPOSE: Seasonal variations in renal colic have been described by many authors for different countries worldwide. In most studies, there was no differentiation with regard to stone composition. Recently, we demonstrated that there was no seasonal variation in renal colic and urine chemistry for calcium oxalate stone formers in Germany. As we have many uric acid stone formers (UASFs) in our region, we were interested in learning the situation of this type of stone. METHODS: We studied 286 consecutive UASFs with symptoms of renal colic. We divided them into four groups according to the quarters of the year. For stone analysis, X-ray diffraction/polarizing microscopy was used. Additionally, the following general parameters were examined in all patients: age, BMI, blood pressure, stone frequency, diabetes mellitus; blood: creatinine, glucose, uric acid, calcium, sodium and potassium; urine: pH, volume, calcium, uric acid, citrate, ammonia, and urea. Using the statistical program Prism 5 (GraphPad Software, San Diego, USA), significant differences between the four groups were calculated by the Kruskal-Wallis test. RESULTS: We observed significantly more UASFs with renal colic in the third and fourth quarters of the year. This is in contrast to our findings in calcium oxalate patients. However, there was no variation in metabolic parameters. CONCLUSION: The reasons are unclear; different temperatures are not a sufficient explanation, as one quarter is in the warm season and the other one is in the cold season. Unfortunately, no data have been reported in the literature thus far. Further studies are required to better understand these findings.
Subject(s)
Kidney Calculi , Renal Colic , Urolithiasis , Calcium , Calcium Oxalate/metabolism , Germany/epidemiology , Humans , Kidney Calculi/epidemiology , Kidney Calculi/metabolism , Renal Colic/epidemiology , Seasons , Uric AcidABSTRACT
OBJECTIVE: The aim of the study was to retrospectively evaluate the prevalence of reported and unreported potentially important incidental findings (PIFs) in consecutive nonenhanced abdominal CTs performed specifically for renal colic in the urgent setting. METHODS: One radiologist, blinded to the finalized report, retrospectively re-evaluated nonenhanced abdominal CTs performed from January to December 2017 on adult patients from the emergency department with the specific request of urgent evaluation for renal colic, searching for PIFs. RESULTS: The CTs of 312 patients were included in the study. Thirty-eight findings were reported in 38 different CTs, whereas the re-evaluation added 47 unreported findings in 47 different CTs, adding to total of 85 findings (27%). The difference in the proportion of reported and unreported PIFs between the original report and re-evaluation was significant (p < 0.001). No significant difference was found between the age of patients with and without reported findings. The proportion of potentially important findings did not vary significantly among the 3 shifts in the original report and in re-evaluation. The most frequent findings, both reported and unreported, were pleural effusion, lymphadenopathies, and liver nodules. CONCLUSIONS: Potentially important additional findings are frequently present in urgent nonenhanced abdominal CTs performed for renal colic, and many are not described in the finalized reports. Radiologists should take care not to underreport PIFs even in the urgent setting because of the possible consequences on the patient's health and in order to avoid legal issues, while at the same time satisfying the need for timely and efficient reporting.
Subject(s)
Incidental Findings , Nephrolithiasis , Renal Colic/diagnostic imaging , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Prevalence , Renal Colic/epidemiology , Retrospective StudiesABSTRACT
We aimed to explore whether a single-day of fasting (SDF) increase emergency room (ER) visits due to renal colic (RC). We elected to concentrate on Yom-Kippur (i.e.: SDF), the holiest day in Judaism. Food and liquid consumption is prohibited during this day for 25 h, and an estimated 50-70% fasting rate is observed. SDF always takes place between mid-September and mid-October during which the temperature in the Middle-East ranges between 19 and 30 °C. ER visits for RC between 01/2012 and 11/2019 were reviewed, and the Gregorian days on which SDF occurred were retrieved. The number of ER visits for RC was compared between SDF and the surrounding days/months as well as to another single-day "standard" holiday (SDSH) that precedes SDF in 10 days and is not associated with fasting. Of 11,717 ER visits for RC, 8775 (74.9%) were males. Male:Female ratio was 3:1. The mean daily number of ER visits for RC during the 3 days following SDF was 6.66 ± 2.49, significantly higher compared with the mean annual daily visits (4.1 ± 2.27, p < 0.001), the mean daily visits during the week prior to SDF (5.27 ± 2.656, p = 0.032), and the mean daily visits during September (5.06 ± 2.659, p = 0.005), and October (4.78 ± 2.23, p < 0.001). The mean number of ER daily visits for RC during the 3 days following SDSH, 5.79 ± 2.84, did not differ compared with the mean daily visits during September and October (p = 0.207; p = 0.13, respectively). It was lower compared to SDF, however statistically insignificant (p = 0.285). A single-day fasting may increase ER visits for RC. The mechanism underlying this phenomenon is unknown.
Subject(s)
Ambulatory Care/statistics & numerical data , Emergency Medical Services/statistics & numerical data , Emergency Service, Hospital , Fasting/adverse effects , Renal Colic/epidemiology , Renal Colic/etiology , Disease Susceptibility , Humans , Public Health Surveillance , Time FactorsABSTRACT
BACKGROUND: Dietary modifications and patient-tailored medical management are significant in controlling renal stone disease. Nevertheless, the literature regarding effectiveness is sparse. OBJECTIVES: To explore the impact of dietary modifications and medical management on 24-hour urinary metabolic profiles (UMP) and renal stone status in recurrent kidney stone formers. METHODS: We reviewed our prospective registry database of patients treated for nephrolithiasis. Data included age, sex, 24-hour UMP, and stone burden before treatment. Under individual treatment, patients were followed at 6-8 month intervals with repeat 24-hour UMP and radiographic images. Nephrolithiasis-related events (e.g., surgery, renal colic) were also recorded. We included patients with established long-term follow-up prior to the initiation of designated treatment, comparing individual nephrolithiasis status before and after treatment initiation. RESULTS: Inclusion criteria were met by 44 patients. Median age at treatment start was 60.5 (50.2-70.2) years. Male:Female ratio was 3.9:1. Median follow-up was 10 (6-25) years and 5 (3-6) years before and after initiation of medical and dietary treatment, respectively. Metabolic abnormalities detected included: hypocitraturia (95.5%), low urine volume (56.8%), hypercalciuria (45.5%), hyperoxaluria (40.9%), and hyperuricosuria (13.6%). Repeat 24-hour UMP under appropriate diet and medical treatment revealed a progressive increase in citrate levels compared to baseline and significantly decreased calcium levels (P = 0.001 and 0.03, respectively). A significant decrease was observed in stone burden (P = 0.001) and overall nephrolithiasis-related events. CONCLUSIONS: Dietary modifications and medical management significantly aid in correcting urinary metabolic abnormalities. Consequently, reduced nehprolithiasis-related events and better stone burden control is expected.
Subject(s)
Diet Therapy/methods , Kidney Calculi , Nephrolithiasis , Aftercare/methods , Aftercare/statistics & numerical data , Calcium/urine , Citric Acid/urine , Female , Humans , Israel/epidemiology , Kidney Calculi/complications , Kidney Calculi/epidemiology , Kidney Calculi/physiopathology , Male , Medication Therapy Management/statistics & numerical data , Metabolome/drug effects , Metabolome/physiology , Middle Aged , Monitoring, Physiologic/methods , Nephrolithiasis/diagnosis , Nephrolithiasis/diet therapy , Nephrolithiasis/drug therapy , Nephrolithiasis/metabolism , Outcome and Process Assessment, Health Care , Renal Colic/epidemiology , Renal Colic/etiology , Secondary Prevention/methods , Secondary Prevention/statistics & numerical data , Surgical Procedures, Operative/statistics & numerical data , Uric Acid/urineABSTRACT
Urolithiasis is a prevalent medical disease affecting the general population. Many epidemiological studies reported an association between a geographic area with a high mean daily temperature and urolithiasis disease. However, it is unclear if the seasonal variation in a high temperature geographical area will affect the acute presentation of renal colic to the emergency department. The aim of this study was to identify the effect of the seasonal variation on the presentation with acute urolithiasis disease. The design was a retrospective chart review, using the database in King Abdulaziz Medical City that was retrieved by the data management office in King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia. The study period was from January 26, 2016, to the end of December 2019. All patients who presented with renal colic, and diagnosed with urolithiasis using a noncontrast-enhanced computed tomography scan, have been included. A total of 1057 patients were included in this study. The majority (71.24%, n = 753) were male, and the mean age was 42.33 ± 16.12 years. The highest proportion presented in summer (31.22%), followed by spring (26.87%), fall (24.12%), and winter (17.79%). The majority of the sample (84.77%) presented with ureteral stones, and 15.23%with kidney stones. Most of the sample (78.33%) had no history of previous stone formation, with 21.67% being current stone former. The acute presentation with urolithiasis is higher during summer, followed by spring, fall, and winter. A public educational program is highly recommended to increase awareness about stone formation and the appropriate avoidance methods. To this end, additional research is required to understand the stone composition and appropriate methods to avoid developing urolithiasis.
Subject(s)
Renal Colic/epidemiology , Seasons , Urolithiasis/epidemiology , Acute Disease , Adult , Female , Humans , Incidence , Male , Middle Aged , Renal Colic/diagnostic imaging , Retrospective Studies , Saudi Arabia/epidemiology , Tomography, X-Ray Computed , Urolithiasis/diagnostic imagingABSTRACT
INTRODUCCIÓN: El cólico renal es una condición médica común en los servicios de urgencia. Representa la manifestación clínica más frecuente de urolitiasis, cuya patogenia es multifactorial, con tasas de prevalencia varía de 1% a 20% y una recurrencia a 10 años del 42% al 50%. OBJETIVO: Establecer el perfil clínico-epidemiológico, como también el diagnóstico y manejo de los pacientes hospitalizados por cólico renal en el Hospital Clínico Herminda Martín (HCHCM). MATERIAL Y MÉTODO: Estudio descriptivo retrospectivo en pacientes hospitalizados con diagnóstico de cólico renal en el HCHM de Chillán en el período marzo 2014-marzo 2019. Se estudiaron las variables: sexo, edad, presentación clínica de ingreso, factores de riesgo asociados, motivo de hospitalización, resultados imagenológicos y manejo clínico. Resultados. El 52,45% correspondió a pacientes de sexo masculino, encontrándose la mayor cantidad de pacientes en el intervalo de 40-49 años. La obesidad, antecedente de urolitiasis e hipertensión arterial fueron las patologías asociadas más frecuentes. En la mayoría de los pacientes, el motivo de la hospitalización fue la refractariedad al tratamiento analgésico, alcanzando un 86,76%. El 56,37% de los pacientes recibió manejo médico expulsivo y a un 19,11% de los pacientes se le realizó una intervención quirúrgica durante la hospitalización. CONCLUSIÓN: El perfil de éstos pacientes no sólo permite establecer medidas que podrían evitar un evento litiásico, sino que además se demuestra la necesidad de realizar un manejo óptimo que puede evitar reconsultas, sobrecarga de los servicios de urgencia, aumento de días cama y complicaciones.
INTRODUCTION: Renal colic is a common condition in the emergency department. It represents the most frequent clinical manifestation of urolithiasis, whose prevalence rate varies between 1% to 20%. Its pathogenesis is multifactorial, with a recurrence of 10 years from 42-50%. OBJECTIVE: Establish the clinical-epidemiological profile, as well as the diagnosis and management of patients hospitalized for renal colic at the Herminda Martín Clinical Hospital(HCHM). MATERIALS AND METHODS: A retrospective descriptive study of hospitalized patients diagnosed with renal colic at the HCHM, March 2014-March 2019, the variables were studied: sex, age, the clinical presentation of admission, associated risk factors, the reason for hospitalization, imaging results, and management. Results: 52.45% were male patients, with the highest number of patients in the range of 40-49 years. Obesity, a history of urolithiasis and hypertension, occurred more frequently within the associated pathologies. In most patients, refractable to analgesic treatment was the reason for hospitalization, reaching 86.76%. 56.37% of patients received expulsion medical management, and 19.11% of patientshad surgeryduring hospitalization. CONCLUSION: The profile of these patients not only allows them to establish measures that could prevent a lithiasis event but also shows the need for effective management of patients who can avoid reconsults, an overload of emergency services, increasedbed days and complications
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Renal Colic/diagnosis , Hospitalization , Kidney Diseases/diagnosis , Epidemiology, Descriptive , Retrospective Studies , Emergency Service, Hospital/statistics & numerical data , Renal Colic/surgery , Renal Colic/epidemiology , Renal Colic/diagnostic imagingABSTRACT
INTRODUCTION: We hypothesized that the recent COVID-19 pandemic may lead to a delay in renal colic patients presenting to the Emergency Department due to the fear of getting infected. This delay may lead to a more severe clinical condition at presentation with possible complications for the patients. MATERIAL AND METHODS: Retrospective review of data collected from three institutions from Spain and Italy. Patients who presented to Emergency Department with unilateral or bilateral renal colic caused by imaging confirmed urolithiasis during the 45 days before and after each national lockdown were included. Data collected included patients' demographics, biochemical urine and blood tests, radiological tests, signs, symptoms and the therapeutic management. Analysis was performed between two groups, Group A: patients presenting prior to the national lockdown date; and Group B: patients presenting after the national lockdown date. RESULTS: A total of 397 patients presented to Emergency Department with radiology confirmed urolithiasis and were included in the study. The number of patients presenting to Emergency Department with renal/ureteric colic was 285 (71.8%) patients in Group A and 112 (28.2%) patients in Group B (p<0.001). The number of patients reporting a delay in presentation was 135 (47.4%) in Group A and 63 (56.3%) in Group B (p=0.11). At presentation, there were no statistical differences between Group A and Group B regarding the serum creatinine level, C reactive protein, white blood cell count, fever, oliguria, flank pain and hydronephrosis. In addition, no significant differences were observed with the length of stay, Urology department admission requirement and type of therapy. CONCLUSION: Data from our study showed a significant reduction in presentations to Emergency Department for renal colic after the lockdown in Spain and Italy. However, we did not find any significant difference with the length of stay, Urology department admission requirement and type of therapy.
Subject(s)
COVID-19/epidemiology , Emergency Service, Hospital/statistics & numerical data , Pandemics , Renal Colic/epidemiology , SARS-CoV-2 , Ureteral Calculi/epidemiology , Adult , Female , Humans , Italy/epidemiology , Male , Middle Aged , Renal Colic/etiology , Retrospective Studies , Spain/epidemiology , Time Factors , Ureteral Calculi/complicationsABSTRACT
PURPOSE: Management of pregnancy and delivery in women with lower urinary tract reconstruction is challenging and the currently available literature is insufficient to guide clinical practice. We report pregnancy and delivery outcomes in this specific population. MATERIALS AND METHODS: We conducted a national multicenter retrospective study (16 centers) including 68 women with 96 deliveries between 1998 and 2019. These women had at least 1 successful pregnancy and delivery after augmentation enterocystoplasty, catheterizable channel creation and/or artificial urinary sphincter implantation. Maternal and fetal complications during pregnancy and delivery were reported, as well as postpartum functional outcomes, according to the delivery mode. The chi-square test and Student's t-test were used to compare categorical and continuous variables, respectively. RESULTS: Overall 32% of reported pregnancies were complicated by febrile urinary tract infections, 13.5% by renal colic and 14.6% required upper urinary tract diversion. In addition, 10% of patients reported transient self-catheterization difficulties and 13.5% reported de novo or increased urinary incontinence. The preterm delivery rate was 35.3%. Elective C-section was performed in 61% of pregnancies. Twenty complications occurred during delivery (20%), including 19 during elective C-section. Urinary continence at 1 year was unchanged for 93.5% of deliveries. Delivery mode (p=0.293) and multiparity (p=0.572) had no impact on urinary continence. CONCLUSIONS: In this population C-section appeared to be associated with a high risk of complications. In the absence of any obstetric or neurological contraindications, vaginal delivery should be proposed as the first line option to the majority of these women.
Subject(s)
Cesarean Section/adverse effects , Plastic Surgery Procedures/adverse effects , Postoperative Complications/epidemiology , Pregnancy Complications/epidemiology , Premature Birth/epidemiology , Adolescent , Adult , Cesarean Section/statistics & numerical data , Female , France/epidemiology , Humans , Multiple Sclerosis/surgery , Postoperative Complications/etiology , Pregnancy , Pregnancy Complications/etiology , Pregnancy Complications/surgery , Premature Birth/etiology , Renal Colic/epidemiology , Renal Colic/etiology , Retrospective Studies , Spinal Cord Injuries/surgery , Spinal Dysraphism/surgery , Urinary Bladder/abnormalities , Urinary Bladder/surgery , Urinary Diversion/statistics & numerical data , Urinary Incontinence/epidemiology , Urinary Incontinence/etiology , Urinary Sphincter, Artificial/adverse effects , Urinary Tract Infections/epidemiology , Urinary Tract Infections/etiology , Young AdultABSTRACT
OBJECTIVE: To evaluate the clinical decision unit of a tertiary care health facility and to see the disease pattern. . METHODOLOGY: The cross-sectional retrospective study was conducted at the Department of Emergency Medicine, Aga Khan University Hospital, Karachi, from September to October 2011, and comprised data of patients admitted to the clinical decision unit from January to December 2010. The protocols were developed for 7 diseases: acute coronary syndrome, ureteric colic, abdominal pain, bronchial asthma, gastroenteritis with dehydration, headache, and minor head injury. Data-collection proforma recorded demographics, dates of admission, presenting complaints at triage, diagnosis at admission, final disposition and bounce back of the patients. Data was analysed using Microsoft Excel 2007. RESULTS: Of the 1515 patients whose data was analysed, 824(54%) were males. The overall age ranged from newborns to 93 years. Further, 904(60%) patients had presented to the triage counter as P3 category. Acute gastroenteritis was the most common complaint 240(15.84%). Of the total, 1311(87%) were sent home from the clinical decision unit; 39(2.8%) of them bounced back with the same complaint. Overall, 2(0.2%) adult patients expired. CONCLUSIONS: The unit evaluated had a productive initial year. Acute gastroenteritis was the most common protocol in use, but other protocols should also be developed to address local needs.
Subject(s)
Clinical Observation Units , Dehydration/therapy , Gastroenteritis/therapy , Hospitalization/trends , Length of Stay/trends , Patient Discharge/trends , Abdominal Pain/epidemiology , Abdominal Pain/therapy , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Asthma/epidemiology , Asthma/therapy , Chest Pain/epidemiology , Chest Pain/etiology , Chest Pain/therapy , Child , Child, Preschool , Clinical Protocols , Craniocerebral Trauma/epidemiology , Craniocerebral Trauma/therapy , Dehydration/epidemiology , Dehydration/etiology , Drug Overdose/epidemiology , Drug Overdose/therapy , Emergency Service, Hospital , Female , Gastroenteritis/complications , Gastroenteritis/epidemiology , Headache/epidemiology , Headache/therapy , Humans , Infant , Infant, Newborn , Male , Middle Aged , Pakistan/epidemiology , Patient Readmission , Pilot Projects , Renal Colic/epidemiology , Renal Colic/therapy , Retrospective Studies , Young AdultABSTRACT
Renal colic is a prevalent emergency department presentation resulting from urolithiasis. Clinical decision rules for the diagnosis of urolithiasis were developed to help clinicians with better judgment. In this systematic review, we assessed the performance of prediction rules on urolithiasis diagnosis and prognosis. MEDLINE, Embase, Web of Science, and Scopus were searched for studies on the performance of a clinical decision tool for diagnosis or prognosis of urolithiasis. Performance and accuracy of the rules were the key outcomes of interest. Databases were searched from inception to March 2019. Of the 4980 articles reviewed, 28 studies were included in the present analysis. Twenty-one studies were on urolithiasis diagnosis (including eight studies on STONE rule), and 10 studies reported urolithiasis outcomes. Studies were at low to moderate risk of bias. The pooling of data on STONE showed that the prevalence of urolithiasis in low, moderate, and high risk groups were: 12% (95% confidence interval 9%-15%), 53% (95% confidence interval 43%-62%), and 83% (95% confidence interval 75%-91%), respectively. In the high risk score group, prevalence of clinically important alternative diagnosis was 1% (95% confidence interval 0%-2%) and 11% (95% confidence interval 8%-13%) of patients needed intervention. STONE scoring system is useful in estimating the prevalence of urolithiasis but high heterogeneity among the studies makes it unsuitable for application. Other decision tools were poorly studied and cannot be recommended for clinical use.
Subject(s)
Renal Colic/diagnosis , Renal Colic/epidemiology , Urolithiasis/diagnosis , Urolithiasis/epidemiology , Comorbidity , Female , Humans , Male , Prognosis , Renal Colic/therapy , Risk Factors , Urolithiasis/therapyABSTRACT
Introduction: A seasonal variation in the frequency of acute stone presentations has been observed in studies from the United States, Africa, and Asia. The increased incidence of acute stone presentations during periods of warm weather has been attributed to both the dehydrating effect of elevated temperatures and the vitamin D related increase in calciuria during periods of increased sunshine. The aim of this study is to establish whether the association between various meteorologic parameters and the frequency of acute stone presentations also exists in a European climate. Methods: All computed tomography kidneys, ureters and bladder scans performed by Emergency Departments within the Dublin Midland Hospital Group between June 2017 and September 2018 were identified from the national radiologic database. The date of scan in addition to stone parameters (site, size, and side) was recorded. These data were then correlated with weather recordings obtained from the Irish meteorologic office. Results: A total of 2441 patients were investigated for suspected renal colic during the study period of which 781 were confirmed to have ureteral stones. An increased frequency of acute stone presentations was observed during the summer months of both years (June, July, and August). Unexpectedly, the heat wave of summer 2018 was not associated with an increased frequency of nephrolithiasis compared with summer 2017. Conclusion: There is an increased frequency of acute nephrolithiasis during the summer months in Ireland. Health care services should be tailored to expect an increase in service needs during these periods of increased activity.
Subject(s)
Renal Colic/epidemiology , Ureteral Calculi/epidemiology , Adult , Aged , Climate , Emergency Service, Hospital , Female , Humans , Incidence , Ireland/epidemiology , Male , Middle Aged , Renal Colic/complications , Renal Colic/diagnostic imaging , Seasons , Tomography, X-Ray Computed , Ureteral Calculi/complications , Ureteral Calculi/diagnostic imagingABSTRACT
OBJECTIVE: To determine whether cerebrovascular risk factors are associated with subsequent diagnoses of Parkinson disease, and whether these associations are similar in magnitude to those with subsequent diagnoses of Alzheimer disease. METHODS: This was a retrospective cohort study using claims data from a 5% random sample of Medicare beneficiaries from 2008 to 2015. The exposures were stroke, atrial fibrillation, coronary disease, hyperlipidemia, hypertension, sleep apnea, diabetes mellitus, heart failure, peripheral vascular disease, chronic kidney disease, chronic obstructive pulmonary disease, valvular heart disease, tobacco use, and alcohol abuse. The primary outcome was a new diagnosis of idiopathic Parkinson disease. The secondary outcome was a new diagnosis of Alzheimer disease. Marginal structural Cox models adjusting for time-dependent confounding were used to characterize the association between exposures and outcomes. We also evaluated the association between cerebrovascular risk factors and subsequent renal colic (negative control). RESULTS: Among 1,035,536 Medicare beneficiaries followed for a mean of 5.2 years, 15,531 (1.5%) participants were diagnosed with Parkinson disease and 81,974 (7.9%) were diagnosed with Alzheimer disease. Most evaluated cerebrovascular risk factors, including prior stroke (hazard ratio = 1.55; 95% confidence interval = 1.39-1.72), were associated with the subsequent diagnosis of Parkinson disease. The magnitudes of these associations were similar, but attenuated, to the associations between cerebrovascular risk factors and Alzheimer disease. Confirming the validity of our analytical model, most cerebrovascular risk factors were not associated with the subsequent diagnosis of renal colic. INTERPRETATION: Cerebrovascular risk factors are associated with Parkinson disease, an effect comparable to their association with Alzheimer disease. ANN NEUROL 2019;86:572-581.
Subject(s)
Alzheimer Disease/epidemiology , Cerebrovascular Disorders/epidemiology , Parkinson Disease/epidemiology , Renal Colic/epidemiology , Aged , Aged, 80 and over , Comorbidity , Female , Humans , Male , Retrospective Studies , Risk Factors , United States/epidemiologyABSTRACT
OBJECTIVES: To evaluate the clinical, fiscal and environmental impact of a specialist-led acute ureteric colic virtual clinic (VC) pathway. PATIENTS AND METHODS: All patients with uncomplicated acute ureteric colic, referred to a single tertiary centre, were prospectively entered into the study over a 4-year period (January 2015-December 2018). Inclusion criteria were: low-dose non-contrast computed tomography of kidneys, ureters and bladder; white blood cell count <16 × 109/L; pain controlled; normal renal function; and no clinical concern. Primary outcomes were: time (days) from referral to VC outcome; VC outcome (discharge, further VC, face-to-face [FTF] clinic, extracorporeal shockwave lithotripsy [ESWL], ureterorenoscopy [URS], percutaneous nephrolithotomy [PCNL]); and adverse events (sepsis or obstruction). Secondary outcomes were patient and stone demographics, cost and environmental analysis. The minimum follow-up was 3 months. RESULTS: A total of 1008 patients entered the study, of whom 91.5% (n = 922) were of working age. The median (interquartile range) time from presentation to VC outcome was 2 (4) days. VC outcomes were as follows: 16.3% of patients (n = 164) were discharged; 18.2% (n = 183) were discharged after further VC; 17.2% (n = 173) underwent an intervention; and 48.4% (n = 488) were referred to an FTF clinic. Interventions comprised: PCNL 0.5% (n = 5); ESWL 7.7% (n = 78); and URS 8.9% (n = 90). Stone demographics were as follows: 570 patients (56.5%) had lower, 157 (15.6%) had upper, 96 (9.5%) had mid-ureteric and 163 (16.2%) had renal calculi, and in 22 patients (2.2%) the stones had recently passed. The mean (sd) stone size was 3.5 (2.3) mm. Two adverse events (0.2%) were reported. Introducing a VC saved £145,152 for Clinical Commissioning Groups, the equivalent NHS tariff payment of performing 106 URS procedures or 211 ureteric stent insertions. Overall, 15,085 patient journey kilometres were avoided, equal to 0.70-2.93 metric tonnes of carbon dioxide equivalent production and the need to plant 14.7 trees to achieve carbon balance. CONCLUSION: A specialist-led acute ureteric colic VC reduced time to treatment decision to a median of 2 days. This creates additional clinic capacity and reduces the fiscal burden of traditional clinics and their associated carbon footprint.
Subject(s)
Carbon Footprint , Renal Colic , Telemedicine , Adult , Carbon Footprint/economics , Carbon Footprint/statistics & numerical data , Costs and Cost Analysis , Female , Humans , Male , Middle Aged , Prospective Studies , Renal Colic/economics , Renal Colic/epidemiology , Renal Colic/therapy , Telemedicine/economics , Telemedicine/statistics & numerical data , Treatment Outcome , Urolithiasis/economics , Urolithiasis/epidemiology , Urolithiasis/therapyABSTRACT
BACKGROUND: Renal colic is a common clinical presentation in emergency. The goal of this study was to describe the epidemiology, current diagnostic and treatment strategies of ureteric colic in our emergency department. METHODS: This is a retrospective study performed over a six months period of patients with clinically suspected renal colic. Data collected included age, sex, urine analysis, ultrasound studies regarding size, site of the stone and presence of hydronephrosis. Comparative statistical analysis was performed using SPSS 12.2 software. RESULTS: Among the total 201 cases, 134(67%) had ultrasound performed which yielded ureteric stone in 61/134 (45.5%) cases, out of which 52.5% (32/61), 32.8% (20/61) and 14.8% (9/61) had stones measuring 5-9.9mm, ≤ 4.9mm and ≥ 10mm respectively. The mean age was 31.6±11 with male: female of 3:1. Hydronephrosis was strongly correlated with the presence of ureteric stone (sensitivity -85.2%, specificity-94.5%, positive predictive value-92.9% and negative predictive value of 88.5%) and was significantly more common with larger stones (p=0.05). Hematuria and pyuria was present among 44.3% (27/61) and 31.1% (19/61) of the ultrasound confirmed ureteric stones respectively. Nonsteroidal anti-inflammatory drugs and smooth muscle relaxants were the most common drug offered. CONCLUSIONS: Ultrasound to detect hydronephrosis, which is the most significant finding, may help to establish the probability of obstruction due to clinically important stone. Absence of hydronephrosis probably suggests small or passed out calculus requiring no immediate urological intervention or may indicate alternate diagnosis. Presence or absence of hematuria cannot be reliable diagnosing and excluding ureteral stones.