Absent hematuria and expensive computerized tomography: Case characteristics of emergency urolithiasis

Purpose: We validated the descriptive characteristics of emergency cases pr esenting with urolithiasis, determined the incidence of normal urinalysis i n such cases and compared the expense of diagnostic computerized tomography (CT) and excretory urography (IVP). Materials and Methods: We retrospectively reviewed the charts of all consec utive patient visits to a community emergency department for 48 months. Exp licit protocols for case selection, data abstraction and monitoring were us ed to maximize accuracy. Entry criteria were urolithiasis diagnosed by IVP, CT or stone passage, and urinalysis. Data analysis included descriptive st atistics and the calculation of confidence intervals. Results: From 159,083 emergency visits during this period 397 met study ent ry criteria. Absent hematuria was noted in 9% (95% confidence interval 7% t o 12%) of patients with proved urolithiasis. There was no correlation of th e degree of obstruction with absent hematuria. Most patients presenting wit h painful urolithiasis were male (73%), in the fifth decade of life (mean a ge 47 years), had stones in the mid ureter (32%) or at the ureterovesicular junction (44%) and received opiates for pain control (91%). Of the patient s 48% presented between 5 p.m. and 7 a.m. when the radiology department was available only for emergency imaging. The diagnosis was made by CT in half of the patients, who were charged $1,409. The maximal insurance reimbursem ent was $673. The diagnosis was made by IVP in half of the patients, who we re charged $445. The maximal insurance reimbursement was $141. Conclusions: Hematuria is not universally present in patients with painful urolithiasis and does not correspond to the degree of obstruction. Despite previous reports to the contrary, CT is significantly more expensive for pa tients than IVP.