Urology Consultation and Emergency Department Revisits for Children with Urinary Stone Disease

Kurtzman, Jane; Song, Lihai; Ross, Michelle; Scales, Charles D.; Chu, David I.; Tasian, Gregory E.

doi:10.1016/j.juro.2018.02.069

Cited by 7 publications

(1 citation statement)

References 24 publications

(26 reference statements)

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“…1 Many children who encounter symptoms of suspected nephrolithiasis will present to a medical center that does not specialize in pediatric care. 2 When a child presents acutely, imaging evaluation is indicated to determine stone size and location, among other factors to help facilitate treatment plans. Ultrasound (US) is the first-line recommended imaging modality for children who present acutely with suspected nephrolithiasis in order to reduce ionizing radiation exposure that may be experienced during CT. 3,4 However, US is limited by lower sensitivity and specificity as compared to CT. 5 US is also operator-dependent and may not be readily accessible after hours at many facilities.…”

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confidence: 99%

Use of Low-Dose Computed Tomography in Children With Nephrolithiasis: An Analysis From 2 Tertiary Pediatric Centers

Pittman,

Paloian,

Pan

et al. 2024

Urology Practice

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Study Need and Importance: Nephrolithiasis has steadily risen in the pediatric population, necessitating a greater need for diagnostic imaging studies. Although ultrasound (US) is the preferred first-line imaging for pediatric nephrolithiasis, CT may be necessary in cases of a nondiagnostic US or when US is not available. As children are more susceptible to the risks of ionizing radiation and may present commonly at adult facilities, we investigated the use of low-dose CTs (LDCTs) for children presenting with nephrolithiasis to 2 pediatric facilities as well as those referred by outside facilities with images already obtained. What We Found: Across 2 tertiary pediatric centers, we reviewed imaging studies and charts of 155 individuals, with 126 (81.3%) receiving standard-dose and 29 (18.7%) receiving LDCT (<3 mGy). Pediatric facilities were more likely to utilize LDCT as compared to referral centers (P < .05; Figure). Older age and higher BMI were also found to be associated with increased radiation dose exposure. Limitations: This retrospective study was unable to determine indications for CT, which may have included a nondiagnostic US or a broader differential such as appendicitis or ovarian torsion that would influence CT protocol. Furthermore, while these results arise from referrals to 2 tertiary pediatric institutions within our state, they may not be broadly generalizable to other practice settings. Interpretation for Patient Care: LDCTs for children with nephrolithiasis are utilized with greater frequency in pediatric health centers. Nonetheless, opportunities exist across health care settings to improve upon LDCT utilization for children with nephrolithiasis.

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confidence: 99%