MP16-03 THE IMPACT OF TIMING OF DEFINITIVE INTERVENTION FOR PATIENTS WITH ACUTE RENAL COLIC: A POPULATION-BASED STUDY
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Résumé
You have accessJournal of UrologyCME1 Apr 2023MP16-03 THE IMPACT OF TIMING OF DEFINITIVE INTERVENTION FOR PATIENTS WITH ACUTE RENAL COLIC: A POPULATION-BASED STUDY Michael Ordon, Sarah Bota, Yuguang Kang, and Blayne Welk Michael OrdonMichael Ordon More articles by this author , Sarah BotaSarah Bota More articles by this author , Yuguang KangYuguang Kang More articles by this author , and Blayne WelkBlayne Welk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003236.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Little data exists on the optimal timing for intervention for symptomatic kidney stones, as such, our objective was to determine the impact of early intervention versus delayed intervention/expectant management for patients presenting to the emergency department (ED) with renal colic. METHODS: We conducted a population-based cohort study in the province of Ontario, utilizing linked administrative health data. Patients who presented to an ED with renal colic between April 1, 2010 to June 30, 2020 were included. Patients were divided into two groups. The early intervention (EI) group underwent shockwave lithotripsy (SWL), ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) within 2-weeks of presentation. The delayed intervention/expectant management (non-EI) group represented all other patients. Patients were followed forward in time for 3 months in the EI group and for 4 weeks post-intervention or 3 months (whichever was longer) in the non-EI group to assess for our outcomes. The outcomes included additional ED visits, hospitalizations or imaging studies, stent or nephrostomy insertion and urologist/primary care visits. These outcomes were compared across the two groups using matched propensity score modelling. RESULTS: There were 397,185 index renal colic events (EI=28,910, non-EI=368,275). The EI group was slightly older and more likely to have a history for stones, hypertension and diabetes (Table 1). The EI group had a lower risk for additional ED visits (RR 0.70 95% CI 0.68-0.72, p<0.001) and hospital admissions (RR 0.52, 95% CI 0.50-0.55, p<0.001) compared to the non-EI group. Similarly, the EI group had a lower risk for stent (RR 0.62, 95% CI 0.54-0.71, p<0.001) or nephrostomy insertion (RR 0.49, 95% CI 0.42-0.57, p<0.001), however there was no difference for additional imaging. The EI group had a slightly increased risk for urologist/primary care visit (RR 1.02, 95% CI 1.02-1.03, p<0.001). In the non-EI group, 17% underwent eventual intervention. CONCLUSIONS: Our population-based study suggests a benefit to EI for those presenting with renal colic to the ED, but potentially with the risk of exposing some patients to unneeded treatment. These findings could influence practice patterns and guideline recommendations moving forward. Source of Funding: Northeastern Section of the AUA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e202 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Ordon More articles by this author Sarah Bota More articles by this author Yuguang Kang More articles by this author Blayne Welk 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 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
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 ».