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Suspected Nephrolithiasis

Pathway Background and Objectives

Studies have demonstrated an increasing incidence of pediatric stone disease over the past 20 years. In addition, there has been a shift to outpatient care of patients with nephrolithiasis, particularly to the Emergency Department setting. Despite published national guidelines for the management of nephrolithiasis, there is regional variability in the use of CT scan as initial imaging modality. This pathway aims to establish a multidisciplinary team approach for the management of pediatric nephrolithiasis at CT Children’s.

The specific objectives of this pathway are to:

  • Standardize the approach to evaluation of pediatric patients presenting for suspected nephrolithiasis/ urinary stones
  • Limit repeated exposure to nephrotoxic medications in patients with abnormal serum creatinine level
  • Appropriate referral to subspecialty services when indicated
  • Appropriate use of radiographic studies

Algorithm

Download Suspected Nephrolithiasis Algorithm

Quality Metrics

  • Percentage of patients seen in the ED who require admission
  • Percentage of patients who have serum BUN/Cr performed
  • Number of patients who undergo CT scan for stone evaluation in the ED
  • Percentage of patients returning to the ED within 48 hours after discharge
  • Percent of patients who received Tamulosin for treatment of confirmed ureteral stone
  • Length of stay (LOS) in the ED for stone event

Educational Module

Download Suspected Nephrolithiasis Educational Module

Key References

  1. Assimos D, et al. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, Part I. J Urol. 2016 Oct;196(4):1153-60.
  2. Pearle MS, et al. Medical Management of Kidney Stones: American Urological Association Guideline. J Urol. 2014 Aug;192(2):316-24.

Pathway Contacts

  • Sherene Mason, MD, MBA
  • Carlos Medina, MD
  • Eric Hoppa, MD

Disclaimer

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.

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