1. Rise in Emergency Department Visits of Pediatric Patients for Renal Colic from John R. Allegra MD, PhD Morristown Memorial Residency in Emergency Medicine Emergency Medicine Associates of NJ Research Foundation

2. Authors Neeraja Kairam MD Barnet Eskin MD, PhD
Morristown Memorial Hospital, Morristown, NJ
Emergency Medical Research Associates Research Foundation

3. Introduction
Renal colic is predominantly a disease of adults with only occasional cases occurring in the pediatric population.
A recent report from a single hospital showed a rise in the number of children with renal colic.

4. Objectives
To confirm in a large multihospital database whether there has been a rise in the number of emergency department visits for renal colic in the pediatric population.

5. Methods Design: Retrospective cohort.
Setting: 29 EDs in New Jersey and New York, USA.

6. Population
All emergency department pediatric patients ( age < 18 years) from to with the ICD-9 diagnosis of “renal colic, calculus kidney, calculus ureter, urinary calculus, or uretheral calculus”

7. Protocol
We analyzed the number of renal colic visits as a percent of the total emergency department pediatric visits in yearly intervals using the Student t test and performed a regression analysis.
Alpha was set at 0.05.

8. Results
The database contained 6.5 million visits of which 1.3 million (20%) were pediatric.
1028 (0.078%) visits were for renal colic
Median age 16 yrs (IQR: yrs)
61% were female.

10. Results
The percentage of ED pediatric visits for renal colic increased from:
0.05% in 1999 to 0.089% in 2008
an increase of 78%
(95% CI: %, p<0.003).
The correlation coefficient for this upward trend was R2= 0.63 (p<0.007).

12. Discussion
We found a marked increase in emergency department pediatric visits for renal colic over the past decade.

13. Discussion
This may reflect a true rise in the incidence of renal colic in the pediatric population or may reflect an increased use of imaging modalities for abdominal and flank pain of uncertain etiology.

14. Limitations
Our study is based on billing ICD 9 codes, which may be biased by physician’s habits with regard to assigning a diagnosis and coders’ assignment of ICD9 codes.
There may also have been a drift in coding practices over the years.

15. Limitations We used as a denominator the total ED visits.
Perhaps a better denominator would be population census data.

16. Limitations We did not have information on the severity of disease.
Our cohort may have included many patients with mild disease.

17. Limitations
The data here may not be representative of all hospital ED's, particularly those in the inner city and rural hospitals.
The patterns may reflect the climate of New York and New Jersey and may not apply to other regions.

18. Conclusion
We found a marked increase in emergency department pediatric visits for renal colic over the past decade.