Epidemiology of Nephrolithiasis Among United States Emergency Departments Over a 9-Year Period.

Authors

Grace V Riley, Kevin G Buell, Eric Moyer, Kyle Bernard, Evan J Panken, Richard J Fantus, Michael Gottlieb

Published in

The Journal of emergency medicine. Volume 91. Pages 1-18. Sep 24, 2026. Epub Sep 24, 2026.

Abstract

Nephrolithiasis is a common emergency department (ED) presentation, yet contemporary national data on management trends are limited.
To characterize recent trends in diagnostic evaluation, management, and disposition for adult ED patients with nephrolithiasis.
This cross-sectional study analyzed United States ED encounters from January 1, 2016 to December 31, 2024 using the Epic Cosmos database, including all adult patients (≥18 years) with an ICD-10 diagnosis of nephrolithiasis. Outcomes included hospital admission, imaging utilization, urine culture collection, medication administration, discharge prescription, and procedural intervention. Descriptive statistics were utilized to characterize the study population. To account for the longitudinal expansion of the database, time-stratified odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the general ED population as a background comparator. Significance of temporal shifts was assessed using Cochran-Armitage tests.
Of 248,564,812 ED encounters, 2,762,879 (1.1%) were for nephrolithiasis. Hospital admission rates increased from 8.9% in 2016 to 12.7% in 2024. Computed tomography (CT) utilization increased (73.8-89.8%), outpacing general ED trends (OR 27.2-45.6), while ultrasound declined (5.8-3.8%). In the ED, opioid use fell (61.5-49.7%), exceeding background reductions (OR 6.6-4.8), while ketorolac was the most common analgesic administered (61.6%). Tamsulosin remained the top discharge prescription (47.2%). Procedural interventions were uncommon, though stent placement increased from 3.0% to 6.8%.
We identified rising hospital admission rates and an increase in CT utilization, while there was a decline in ultrasound. This divergence between practice patterns and evidence-based guidelines, highlights critical opportunities for quality improvement.

PMID:
42933196
Bibliographic data and abstract were imported from PubMed on 27 Oct 2026.

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