PD59-05 OUTCOMES OF MEDICAL VS INTERVENTIONAL MANAGEMENT FOR ACUTE URETERAL COLIC IN EMERGENCY DEPARTMENT PATIENTS
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Résumé
You have accessJournal of UrologyStone Disease: Surgical Therapy V (PD59)1 Apr 2019PD59-05 OUTCOMES OF MEDICAL VS INTERVENTIONAL MANAGEMENT FOR ACUTE URETERAL COLIC IN EMERGENCY DEPARTMENT PATIENTS Grant Innes, Alec Mitchell*, Bryce Weber, Joel Teichman, Kevin Carlson, Andrew McRae, Michael Law, Frank Scheuermeyer, Eric Grafstein, and James Andruchow Grant InnesGrant Innes More articles by this author , Alec Mitchell*Alec Mitchell* More articles by this author , Bryce WeberBryce Weber More articles by this author , Joel TeichmanJoel Teichman More articles by this author , Kevin CarlsonKevin Carlson More articles by this author , Andrew McRaeAndrew McRae More articles by this author , Michael LawMichael Law More articles by this author , Frank ScheuermeyerFrank Scheuermeyer More articles by this author , Eric GrafsteinEric Grafstein More articles by this author , and James AndruchowJames Andruchow More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000557217.76960.69AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Ureteric colic is a common condition that causes severe pain and generates substantial health system utilization. Traditional management includes analgesia and a trial of spontaneous passage, which can succeed, but passage may take weeks and cause severe morbidity. Early stone removal is an alternative, but uptake is variable. Stone removal rapidly improves patient outcomes by relieving obstruction and pain, but to date there has not been a study comparing early intervention with spontaneous passage, and there is little evidence clarifying patients most likely to benefit. METHODS: We looked at two health regions, Calgary Health Region, which serves 1.4 million people and Vancouver Coastal Health (VCH) region which serves 1.2 million. Using regional admin databases we identified all emergency department (ED) patients with a diagnosis of renal colic based on ICD-10 codes. Eligible patients had CT to confirm a stone 2.0-9.9mm in size. Exclusion criteria were used based on stone and patient specific factors. Two cohorts were studied; an early intervention group, which underwent surgical intervention within 3 days of ED presentation and a trial of spontaneous passage group, which did not receive intervention for >5 days. RESULTS: We studied 3081 ED patients with well-characterized ureteral stones. 1168 (37.9%) underwent early surgical intervention and 1913 (62.0%) had a trial of spontaneous passage. Patients that underwent spontaneous passage saw adverse outcomes increase in linear fashion with increasing stone width and proximal location. In early intervention patients, outcomes are relatively constant regardless of stone size, but worse with proximal location. See table 1. CONCLUSIONS: This study provides strong evidence for specific stone parameters to guide early intervention in patients presenting with ureteral colic. This data suggests that patients having low risk stones (width <5mm) undergo a trial of spontaneous passage, that patients having high-risk stones (width >7.0mm or proximal-middle >5mm) be offered early surgical intervention, and that those with medium-risk stones (distal, >5.0mm) be managed on a case-by-case basis. These recommendations are more aggressive than current American guidelines, which recommend a trial of spontaneous passage at <10mm. Source of Funding: none Calgary, Canada; Vancouver, Canada; Calgary, Canada; Vancouver, Canada; Calgary, Canada© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e1092-e1092 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Grant Innes More articles by this author Alec Mitchell* More articles by this author Bryce Weber More articles by this author Joel Teichman More articles by this author Kevin Carlson More articles by this author Andrew McRae More articles by this author Michael Law More articles by this author Frank Scheuermeyer More articles by this author Eric Grafstein More articles by this author James Andruchow More articles by this author Expand All Advertisement PDF downloadLoading ...
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,013 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,058 | 0,006 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».