Trends in Imaging for Suspected Urinary Stones in the Emergency Department

Nearly a decade ago, a large study showed that an ultrasonography-first approach — followed by computed tomography (CT) if necessary — yielded similar outcomes as a CT-first approach for patients with suspected urinary stone disease (USD) who present to an emergency department (ED; NEJM JW Gen Med Oct 15 2014 and N Engl J Med 2014; 371:1100). However, whether that study changed practice is unclear.

In this study, U.S. researchers evaluated imaging trends from 7.5 million unique ED visits for suspected USD from 2012 to 2018. Most visits were followed by discharge from the ED (89% in 2012 and 96% in 2018). Imaging increased from 50% in 2012 to 61% in 2018. However, this change was mostly due to increased CT imaging (49%–59%), not increased ult…