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TOPLINE
Over 9 years, CT use for the diagnosis of kidney stones in US emergency departments (EDs) increased from 73.8% in 2016 to 89.8% in 2024; however, ultrasound use declined from 5.8% to 3.8%. Hospital admissions for nephrolithiasis increased from 8.9% to 12.7%, highlighting a shift toward greater CT use and inpatient management.
METHODOLOGY
- Researchers conducted a cross-sectional study using the Epic Cosmos database, an aggregated, de-identified electronic health record platform that included data from more than 42,000 hospitals and clinics across the US and covered ED encounters from 2016 to 2024.
- The study population included 248,564,812 adult ED encounters, of which 2,762,879 were due to a diagnosis of nephrolithiasis based on International Classification of Diseases, 10th Revision.
- Researchers assessed the total number of ED presentations, rates of hospital admissions, imaging utilization (CT and ultrasound), urine culture collection, ED medication administration, discharge prescriptions, and procedural interventions—including the placement of a ureteral stent and a nephrostomy tube and ureteroscopy with laser lithotripsy—identified via Current Procedural Terminology codes.
- Patients with and without nephrolithiasis were compared by age, sex, ethnicity, race, geographic region, and insurance type.
TAKEAWAY
- Hospital admissions for nephrolithiasis increased from 8.9% in 2016 to 12.7% in 2024.
- CT use increased from 73.8% to 89.8% over the same period, whereas ultrasound use declined from 5.8% to 3.8% (P < .001 for both trends). The normalized odds ratio (OR) for CT use among patients with nephrolithiasis, relative to the general ED population, increased from 27.2 (95% CI, 26.9-27.6) to 45.6 (95% CI, 45.2-46.0).
- Urine culture collection increased from 25.0% to 28.7% (P < .001). ED opioid administration declined from 61.5% to 49.7% (P < .001 for trend). The most commonly administered analgesic was ketorolac (61.6%).
- Tamsulosin remained the most frequently prescribed discharge medication, increasing from 46.3% in 2016 to 49.8% in 2024 (P < .001 for trend), although its OR relative to the general ED population declined over the same period. Discharge opioid prescriptions increased from 8.8% to 14.7% (P < .001 for trend), and nonsteroidal anti-inflammatory drug prescriptions rose from 23.5% to 32.3% (P < .001 for trend). Cystoscopy with stent placement increased from 3.0% to 6.8% (P < .001 for trend).
IN PRACTICE
"Nephrolithiasis remains a common and increasing reason for ED visits, with a steady rise in hospital admissions over time. There have been notable shifts in management, including a substantial increase in CT utilization relative to general ED trends and a decline in opioid administration in favor of non-opioid analgesics," the authors wrote.
"Understanding these contemporary practice patterns can help guide quality improvement initiatives for diagnostic imaging and disposition decisions in the ED," they added.
SOURCE
The study was led by Grace V. Riley, MPH, Rush University Medical College, Chicago. It was published online on September 23, 2026, in The Journal of Emergency Medicine.
LIMITATIONS
The Epic Cosmos database expanded during the study period, potentially influencing longitudinal trends. The reliance on diagnostic codes may have overrepresented patients who received CT imaging. Given the observational design of the study, some imaging may have been obtained for other indications, and other concomitant conditions may have influenced admission rates or medication selection. Additionally, medications taken before ED arrival and rates of urologic consultation were not assessed.
DISCLOSURES
Funding information was not provided for the study. The authors reported having no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
