Login to Access Video or Poster Abstract: MP66-01
Sources of Funding: None

Introduction

Revisiting the emergency department (ED) after discharge is an undesired clinical outcome that remains unstudied in children with kidney stones. We sought to determine the rate of stone-related ED revisits among children, to characterize the reasons for revisiting and to identify patient-, hospital- and clinical characteristics associated with ED revisit. _x000D_

Methods

In a retrospective population-based cohort study of patients ≤18 years with urinary stone disease, ED revisits within 180 days of the index visit were identified in the South Carolina Medical Encounter database. This database includes all ED visits in the state from December 30, 1995 to September 30, 2015. We used discrete time failure models to describe the rate of ED revisit risk over the 180-day period following the index visit. Multivariable logistic regression models were used to estimate the association between patient, hospital and clinical characteristics and ED revisit.

Results

Among 5,642 index stone episodes, 11% led to a stone-related ED revisit within 180 days of discharge. Nearly 60% of these revisits occurred within 30 days of discharge. The odds of revisit within the first 2 days after discharge were 23 times higher than the odds of revisit after 2 weeks from discharge (OR 22.6, 95% CI 18.0 - 28.5, Figure 1). The most common documented symptom at revisit was pain, which occurred in 40% of patients. Nearly 40% of patients underwent surgery and/or hospital admission at the time of revisit. Each year increase in age (OR 1.06, 95% CI 1.03 - 1.10) and public insurance (OR 1.46, 95% CI 1.21 - 1.77) were associated with an increased risk of ED revisit. Patients with a history of stone disease were two times more likely to revisit than patients with no prior history (OR 2.1, 95% CI 1.74 - 2.56). Patients evaluated by a urologist were 40% less likely to revisit the hospital than those who were not (OR 0.6, 95% CI .42 - 0.86).

Conclusions

Children who present to the ED with kidney stones are at most likely to return to the ED within 48 hours of discharge. Older children, publicly insured patients and repeat stone-formers are at greatest risk of ED revisit. Urology consultation is associated with a decreased risk of revisit. Future studies should seek to identify processes of care that decrease ED revisits among high-risk patients.

Funding

None