Medical expulsive therapy use in emergency department patients diagnosed with ureteral stones

Am J Emerg Med. 2017 Aug;35(8):1069-1074. doi: 10.1016/j.ajem.2017.02.040. Epub 2017 Feb 28.

Abstract

Objective: Recent studies have clarified the role of alpha-blockers, such as tamsulosin, for patients diagnosed with ureteral stones <10mm not requiring an urgent intervention. Prior studies have reported low rates of use of MET by emergency physicians. We sought to describe patterns of alpha-blocker use and to determine factors associated with utilization in patients diagnosed with ureterolithiasis in the ED.

Methods: We used data from a randomized trial of CT scan vs. ultrasound in participants with suspected urolithiasis enrolled at 15 EDs between October 2011 and February 2013. The use of medical expulsive therapy was identified by the prescription of an alpha-blocker, calcium channel blocker, or steroid at the ED visit. The prevalence of alpha-blocker use in participants with ureteral stones on imaging was calculated, and multivariable models were used to examine risk factors for utilization.

Results: Of the 524 participants who were identified with a ureteral stone on CT scan and discharged from the ED, 375 (71.4%) received an alpha-blocker, and 2 (<1%) received a steroid. There was no significant difference in alpha-blocker use for participants based on stone size or location. However, there was a 3.6-fold difference in alpha-blocker use between the lowest and highest use ED sites. In the multivariable analysis, ED site was independently associated with utilization of alpha-blockers.

Conclusions: Alpha-blockers were prescribed in more than two-thirds of patients with a distal ureteral stone on imaging, a much higher prevalence than previously reported. There was substantial variability in alpha-blocker use based on ED site.

Publication types

  • Observational Study

MeSH terms

  • Adrenergic alpha-1 Receptor Antagonists / therapeutic use*
  • Adult
  • Analgesics / therapeutic use
  • Calcium Channel Blockers / therapeutic use*
  • Emergency Service, Hospital*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Randomized Controlled Trials as Topic
  • Sulfonamides / therapeutic use*
  • Tamsulosin
  • Tomography, X-Ray Computed*
  • Treatment Outcome
  • United States
  • Urolithiasis / diagnostic imaging
  • Urolithiasis / drug therapy*
  • Urolithiasis / pathology

Substances

  • Adrenergic alpha-1 Receptor Antagonists
  • Analgesics
  • Calcium Channel Blockers
  • Sulfonamides
  • Tamsulosin