Which objective emergency department parameters leads to expedited intervention in patients with acute urinary tract calculi

OBJECTIVES: To retrospectively determine which objective measurements had an increased likelihood of requiring immediate surgical intervention in patients presenting to the emergency department (ED) with acute ureteral calculi. MATERIALS AND METHODS: Employing our institution's electronic medical record system, we conducted a retrospective cohort study of 4366 patients who presented to the ED with an acute ureteral calculus over an 8-year period. Data consisting of relevant demographic information, vital signs, laboratory parameters, and interventional history was obtained and analyzed. RESULTS: This study consisted of 4366 patients presenting to the ED with acute ureteral calculi, of whom 312 (7%) required a procedure prior to being discharged. Of these 312 patients, 290 (6.6%) underwent cystoscopy with ureteral stent placement and 22 (0.5%) were sent to interventional radiology for percutaneous nephrostomy tube placement. Patients who tested positive for nitrites in their urine had a relative risk of 3.48 of receiving intervention when compared to the nitrite negative group. CONCLUSIONS: Through this retrospective cohort study, we were able to find what objective measurements were associated with an increased need for immediate surgical intervention in patients who presented to the ED with acute ureteral calculi. With this data, urologists can be better equipped to identify the patients that present in the emergency setting that will require urgent intervention.