The authors aimed to identify clinical predictors for emergency department (ED) revisits in patients diagnosed with ureteral stones. Patients presenting between 2010 and 2013 were included. Those who were admitted at the initial presentation were excluded. CT scans were reviewed independently to confirm stone size, its location and severity of hydronephrosis. Proximal ureter was defined as the segment above the sacroiliac joint (SIJ), mid-ureter overlying the SIJ and lower ureter below SIJ. Pain severity was assessed on a scale of 0-10. The primary outcome was a 30-day revisit due to stone-related symptoms. Records were reviewed of 1510 patients aged18 years or older with a diagnosis of ureteral stone (average size 4.2 +/- 2.2mm). Of these, 11% (164) re-presented within 30 days with a median time of three days. Patients with revisit were found to be younger (44 vs. 47 years). When age was categorised, those younger than 30 years were more likely to return. It was found that the proximal ureteral location of stone was also associated with revisits relative to distal location (34 vs. 23%) and so was the need for intravenous narcotics in the ED. The authors recommended that in these three groups, early follow-up or intervention with either shock wave lithotripsy or ureteroscopy should be given consideration. 

Clinical predictors of 30-day emergency department revisits for patients with ureteral stones.
Ganesan V, Loftus CJ, Hinck B, et al.
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Zeeshan Aslam

Ninewells Hospital, Dundee, UK; Surgical Tutor, RCPS Glasgow.

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