PD59-05 OUTCOMES OF MEDICAL VS INTERVENTIONAL MANAGEMENT FOR ACUTE URETERAL COLIC IN EMERGENCY DEPARTMENT PATIENTS
Bibliographic record
Abstract
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 ...
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.058 | 0.006 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".