Emergency department utilization patterns for pediatric urinary stone patients in the United States.

Background: The prevalence of pediatric urolithiasis has increased rapidly, leading to more emergency department (ED) visits across the United States.

Objective: The purpose of this study was to determine emergency care practices for children and adolescents with urinary stones and characteristics associated with management.

Methods: We performed a cross-sectional study of the 2021 Nationwide Emergency Department Sample to identify pediatric patients (≤21 years) presenting to an ED in the United States with a primary diagnosis of urinary stone disease. The primary outcome was patient disposition. Multivariable logistic regression was used to identify patient and hospital characteristics associated with hospital admission. Imaging utilization was a secondary outcome of the study.

Results: There were 57 pediatric ED visits for urinary stone disease per 100,000 population in the study (mean age 17.7 years; 59.6 % female). Most patients (91.2 %) were treated and discharged, while 6.9 % were admitted to the same hospital. Computed tomography was the primary imaging modality (60.2 %), with utilization increasing with age. Considerable variability in disposition and imaging utilization was observed, with hospital admission rates ranging from 1.3 % to 55.1 % and CT use from 1.7 % to 77.5 % among patient and hospital subgroups.

Conclusions: This study reveals a high rate of pediatric urinary stone presentations to United States EDs. Significant variations in disposition and imaging utilization across different patient and hospital characteristics highlight the need for standardized, evidence-based approaches to pediatric urinary stone care.