High Rate of Repeat ED Visits for Kidney Stones

Eleven percent of patients seen in the emergency department (ED) for kidney stones make a repeat ED visit within 30 days, reports a study in Academic Emergency Medicine.

Using a California ED database, the researchers identified 128,564 patients with initial treat-and-release visits to EDs for kidney stones in 2008 to 2009. Of those, 13,684 patients made at least one additional ED visit for their kidney stones within 30 days: a rate of 11 percent. Repeat visits were more frequent for younger patients, for patients receiving Medicaid, and in rural areas with a lower workforce supply of urologists. The rates of repeat visits varied substantially among hospitals.

Twenty-nine percent of patients with repeat visits either were hospitalized or underwent an urgent procedure. These outcomes were more likely for patients aged 75 or older, odds ratio (OR) 3.90; for women, OR 1.82; and for patients living in areas with a higher supply of urologists, OR 1.77. Repeat visits were less likely for patients who had a white blood cell count at their initial ED visit, OR 0.86.

Kidney stones are a common reason for ED visits, and more than 90 percent of patients are treated and released. Preventing repeat visits is important to reduce the “excruciating pain” of kidney stones and to reduce health care costs.

The findings suggest that that one of nine patients makes a repeat ED visit for kidney stones. Close to one-third of these repeat visits result in hospitalization or an urgent procedure. Markers of access and quality of care may be useful targets for efforts to reduce high-cost, high-acuity repeat visits for kidney stones [Scales CD Jr., et al. Emergency department revisits for patients with kidney stones in California. Acad Emerg Med 2015; 22:468–474].