NON-NARCOTIC EMERGENCY MANAGEMENT OF RENAL COLIC IMPROVES LENGTH OF STAY AND DISCHARGE RATE
Ketorolac has been reported to be efficacious but underutilized in Emergency Department (ED) management of renal colic. In this study, we examine a large homogenous cohort of patients presenting to ED and document patterns of care and associated outcomes.
Stone patients presenting to ED within a major metropolitan health system were identified by discharge diagnosis. Discrete data elements were recorded prospectively within electronic health record. Narrative elements were abstracted by chart review. Inclusion criteria included: age ≥ 18; CT confirmed ureteral stones (2-10 mm); initial pain score ≥ 6/10; and initial medical treatment with ketorolac only (KO), narcotic only (NO), or both ketorolac and narcotic (KN) administered within a 10-minute interval. Exclusion criteria: prior ED encounter within 120 days.
Inclusion criteria were satisfied in 1,335 of 3,505 ED patients. Initial and secondary analgesic treatment is detailed in table 1. Univariate analysis demonstrated that stone size and location were similar between groups (table 2). Initial pain scores were slightly but progressively higher across KO, NO, and KN (p<0.001). KO patients received less ondansetron and had the highest discharge rate. NO patients had the longest length of stay (LOS) and lowest discharge rate. Multivariable analysis was performed, controlling for age, sex, initial pain score, time to first medication, stone size and location. Among discharged patients, KO (odds ratio 1.9X, 95% confidence interval 1.3-2.8, p<0.001) and KN (1.6X, 1.1-2.3, p<0.009) were more likely than NO to have LOS <3 hours. KN (2.1X, 1.1-4.0, p=0.028) and NO (4.0X, 2.2-7.2, p<0.001) were more likely than KO to be admitted to hospital from ED. </p>
In this setting, initial therapy was empiric (>90% before CT) with 60% of patients receiving ketorolac alone or in combination. Ketorolac administration was associated with superior LOS and discharge rates, and offering ketorolac to more patients could improve outcomes.