Presented by: Christopher Connors BA
Icahn School of Medicine at Mount Sinai

Introduction

Concern for radiation exposure has increased interest in ultrasound (US) for imaging of upper urinary tract calculi (UUTC) in the emergency department (ED). However, it is still unclear how practice patterns have evolved in the United States. We evaluated recent UUTC imaging trends using a national database.

Materials

The National Hospital Ambulatory Medical Care Survey was queried from 2010 to 2020 for ED visits of adults with a UUTC diagnosis. Trends in frequency of US, computerized tomography (CT), and X-ray imaging were analyzed using logistic regression. Multivariate analysis identified predictors of US, CT, and X-ray imaging. 

Results

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2199 UUTC visits were identified, representing a national estimate of 1.2 million annual ED visits with a UUTC diagnosis. 73% of visits used CT, 13% used X-ray, and 7% used US. Linear trendlines from 2010 to 2020 estimate that CT use decreased by 0.4% (p = 0.812), X-ray use decreased by 5.1% (p = 0.013), US use increased by 10.5% (p < 0.001), and the use of US only (no additional CT or X-ray) increased by 2.6% (p = 0.036). On multivariate analysis, Hispanic ethnicity (OR = 1.857) was a significant predictor of US while age between 60 and 70 (OR = 0.256) or 70+ years (OR = 0.046), no insurance (OR = 0.442), and pain on a level of 8-10 on a 10-point scale (OR = 0.531) were negative predictors, all p < 0.05. Age greater than 70 (OR = 2.371) and an 8-10 pain level (OR = 1.577) were predictors of CT, while Black race (OR = 0.666) was a negative predictor, all p < 0.05. Medicare or Medicaid (OR = 1.542) predicted receiving an X-ray, while an 8-10 pain level (OR = 0.637) was a negative predictor, all p < 0.05.

Conclusion

The utilization of US in the diagnosis of UUTC in the ED has significantly increased while X-ray use has decreased, but this has not corresponded with a change in CT imaging. Race, age, pain, and insurance type may play a significant role in imaging selection. Future studies should identify imaging strategies that ensure accurate diagnosis of UUTC while minimizing radiation exposure for all patient populations.

Funding

None

Co-Authors

Micah Levy, BS
Icahn School of Medicine at Mount Sinai

Chih Peng Chin, MD
Icahn School of Medicine at Mount Sinai

Olamide Omidele, MD
Icahn School of Medicine at Mount Sinai

Francisca Larenas, MD
Icahn School of Medicine at Mount Sinai

Michael Palese, BS
Icahn School of Medicine at Mount Sinai