Login to Access Video or Poster Abstract: MP90-15
Sources of Funding: None

Introduction

NSAIDs should be considered first line for the management of renal colic. Despite numerous RCTs supporting their use in clinical practice, NSAIDs are often inconsistently used in patients with renal colic in the emergency department (ED). We examined the use of NSAIDs and effects on outcomes in patients with renal colic and those with ureteral stones who presented to the ED.

Methods

A retrospective analysis was conducted on all consecutive patients with an ICD-9 diagnosis of kidney calculus (592.00), ureteral calculus (592.1), and renal colic (788.0) who presented to our ED between October 2011 and August 2013. We only included patients that presented to the ED then were discharged. For our secondary analysis we only included patients with a confirmed ureteral stone based on imaging.

Results

A total of 330 patients were available for analysis. NSAIDs were the first choice in 49.1% (162/330) of patients and was utilized in 67.1% (221/330) of patients. Those given NSAIDs first were significantly less likely to need additional pain medications than those given narcotics first (p=0.006). When performing a subgroup analysis of patients returning to the ED within 30 days, NSAIDs were used significantly less at discharge (47.6% vs 24%, p=0.015) while there was no difference in narcotic prescriptions. Furthermore, we repeated the analysis for patients returning to the ED within 30 days with a confirmed ureteral stone on imaging and found a significantly less rate of NSAID use at discharge in those that returned (53% vs 17.7%, p=0.006). No other factor was predictive of a return visit to the ED.

Conclusions

Despite clear evidence towards the use of NSAIDs in the acute setting for renal colic, variability still exists in the way ED practitioners prescribe these medications. NSAID use may contribute to less need for additional pain medications and may decrease early return visits (within 30 days) to the ED.

Funding

None