SAN DIEGO, CA USA (UroToday.com) - Dr. Khurshid Ghani and colleagues presented the first analysis of the incidence and costs of imaging for hematuria in the emergency department (ED) setting using the Nationwide Emergency Department Sample (NEDS) data (U.S. population-based cohort) to determine the prevalence, costs and predictors of imaging utilization in patients who presented to ED with hematuria between 1/1/2006 and 12/31/2009.
They were able to capture a weighted sample of 718 914 patient visits to ED, with hematuria as the primary diagnosis. Of these, 13.2% underwent an imaging procedure in the ED. Over the course of the study period, the incidence of imaging for hematuria in ED visits increased from 6.56 to 9.39 per 100 000 person years. The median charges for an ED visit for hematuria, without imaging, was $1138, and with imaging this was estimated around $4300. As such, imaging was associated with an increase in ED charges of $75M per year. Moreover, the following variables were independent predictors of a lower likelihood of obtaining imaging: non-metropolitan hospitals vs metro hospitals (OR=0.25, p < 0.0001), hospitals in the Midwest vs other regions (OR=0.28, p < 0.0001), Medicaid (OR=0.73, p < 0.0001) and Medicare (OR=0.56, p < 0.0001) vs private insurance.
Although upper-tract imaging is an essential part of hematuria workup, with implementation of evidence-based practice, unnecessary cross-sectional imagings can certainly be eliminated and can reduce overall health care cost. Informing primary care and ED physicians with urology guidelines (eg. hematuria, small renal masses, nephrolithiasis, etc.) plays a crucial role here.
Presented by Khurshid R Ghani, Shyam Sukumar, Jesse D Sammon, Al'a Abdo, Orchidee Djahangirian, Wooju Jeong, James O Peabody, Shahrokh F Shariat, Pierre I Karakiewicz, Maxine Sun, Mani Menon, and Quoc-Dien Trinh at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Reported for UroToday.com by Reza Mehrazin, MD