The Impact of Timing of Definitive Intervention for Patients with Acute Renal Colic: A Population-Based Study
Bibliographic record
Abstract
Objective: To determine the impact of early intervention (EI) vs delayed intervention/expectant management for patients presenting to the emergency department (ED) with renal colic. Methods: We conducted a population-based cohort study in Ontario, Canada, utilizing linked administrative health data. Patients presenting to an ED with renal colic between April 1, 2010, and June 30, 2020, were included. Patients were divided into two groups. The EI group underwent shockwave lithotripsy, ureteroscopy, or percutaneous nephrolithotomy within 2 weeks of presentation. The delayed intervention/expectant management (non-EI) group represented all other patients, including those who did not receive intervention. Patients were followed forward in time for 3 months in the EI group and for 4 weeks postintervention 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/nephrostomy insertion, and urologist/primary care visits. These outcomes were compared across the two groups using a propensity score-matched generalized linear model with generalized estimating equations. Results: There were 397,185 index renal colic events (after propensity score matching EI = 27,741, non-EI = 80,230). The EI group had a lower risk for additional ED visits (relative risk (RR): 0.70, 95% confidence interval (CI): 0.68–0.72, p < 0.001) and hospital admissions (RR: 0.52, 95% CI: 0.50–0.55, p < 0.001) compared with 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, 17.31% underwent eventual intervention. Conclusion: Our study demonstrated 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.
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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 | 0.002 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".