PD14-12 IMPACT OF AUA RECOMMENDATIONS ON IMAGING TRENDS IN THE FOLLOW-UP OF URETERAL CALCULI (2016)

You have accessJournal of UrologyImaging/Radiology: Uroradiology IV1 Apr 2016PD14-12 IMPACT OF AUA RECOMMENDATIONS ON IMAGING TRENDS IN THE FOLLOW-UP OF URETERAL CALCULI Anika Ackerman, Joanne Dale, Adam Kaplan, Tony Chen, Laura Ding, Glenn Preminger, Charles Scales, and Michael Lipkin Anika AckermanAnika Ackerman More articles by this author , Joanne DaleJoanne Dale More articles by this author , Adam KaplanAdam Kaplan More articles by this author , Tony ChenTony Chen More articles by this author , Laura DingLaura Ding More articles by this author , Glenn PremingerGlenn Preminger More articles by this author , Charles ScalesCharles Scales More articles by this author , and Michael LipkinMichael Lipkin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1009AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with symptomatic ureteral calculi often undergo imaging studies; associated costs and radiation doses can be substantial. To address these concerns for patients with ureteral stones, The AUA recently published an imaging clinical effectiveness protocol. We assessed the impact of these recommendations on utilization, cost, and radiation exposure for patients at our institution. METHODS We conducted a retrospective chart review of patients who presented to the emergency department with a ureteral stone during the time period one year before and after the AUA protocol was released. Patients who underwent a CT scan confirming the presence of a ureteral stone and who had follow-up with our urology department were included. We collected data regarding demographics, stone history, stone size and location, follow-up imaging obtained, effective radiation dose from imaging, and clinical outcomes. Primary outcome was the number of CT scans, abdominal X-rays (KUB), and ultrasounds (US) obtained for follow-up imaging after a period of conservative management before and after the release of the 2013 AUA protocol. Secondary outcomes included cost of imaging determined by the fees billed at our institution and radiation exposure. Statistical analysis was performed using Chi-square test, Wilcoxon rank sum test, and logistic regression. RESULTS Data from 117 medical charts (before protocol, 59; after protocol, 58) were included. 27% of patients underwent follow-up CT scan before and 12% after protocol release (p=0.0406). Cost of follow-up imaging, including CT, KUB, and US, decreased by a mean of $1,030 and effective radiation dose from all imaging decreased by a mean of 2.88mSv after protocol release, however these differences were not significant (p=0.0788 and p=0.0592). Of the patients who did not have a follow-up CT, we found similar rates of clinical outcomes, including surgical management, stone passage, and loss to follow up, before and after protocol release. Logistic regression failed to identify any significant predictors of obtaining repeat CT scan on follow-up. CONCLUSIONS Since the AUA released the 2013 Clinical Effectiveness Protocol for imaging in the management of ureteral calculous disease, our endourology department has significantly decreased utilization of CT scan for follow-up of observed ureteral stones without a negative impact on patient care or serious adverse outcome. Continued adherence to the protocol will likely lead to a significant reduction in cost and radiation exposure. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e307-e308 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Anika Ackerman More articles by this author Joanne Dale More articles by this author Adam Kaplan More articles by this author Tony Chen More articles by this author Laura Ding More articles by this author Glenn Preminger More articles by this author Charles Scales More articles by this author Michael Lipkin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...