Login to Access Video or Poster Abstract: MP01-09
Sources of Funding: None

Introduction

American Urological Association guidelines recommend a combination of ultrasound (US) and kidney, ureter, bladder film (KUB) for monitoring patients with known ureteral calculous disease. We implemented a protocol of KUB and US for patients with known renal and/or ureteral calculous disease to investigate the subsequent use of computed tomography (CT) imaging and 90-day outcomes.

Methods

We conducted a retrospective review of patients who presented in an outpatient setting with a known ICD-9 diagnosis of renal and/or ureteral calculous disease whose evaluation involved a request for CT imaging. Included patients presented between November 1, 2013 and May 31, 2014, were non-pregnant adults (>18 years old), and had no US or KUB within 60 days of CT imaging request. CT requests were sent to a specialty benefits management company (SBM), from which the data were obtained, and a third party payer. For CT imaging to be approved, the SBM required US or KUB within 60 days prior to CT imaging request. Two cohorts were evaluated: 1) approved initial CT (iCT) request and 2) redirected CT request to initial US or KUB (iUS/KUB). Requests for the iCT cohort were approved because providers attested to prior US or KUB within 60 days, while CT imaging requests for the iUS/KUB cohort were redirected because providers did not attest to prior US or KUB within 60 days. Subsequent 90-day outcomes were analyzed including need for further CT imaging, emergency department (ED) visits, and hospitalizations.

Results

A total of 1307 patients were evaluated. The iUS/KUB cohort (n=447) underwent a significantly lower percentage of CT scans compared to the iCT cohort (n=860) (43.8% vs. 52.1%, p<0.005). There were no significant differences between the iUS/KUB and iCT cohorts in subsequent ED visits (7.4% vs. 6.7%, p=0.67) or hospitalizations (13.6% vs. 15.0%, p=0.51).

Conclusions

The use of US or KUB for outpatients with known renal and/or ureteral calculous disease was associated with reduced utilization of CT imaging without significantly affecting 90-day ED visits or hospitalizations compared with patients undergoing CT alone. These results may contribute to reducing the effective dose of radiation delivered to patients and may optimize resource utilization while maintaining similar patient outcomes.

Funding

None