Drug Therapy for Stones Underused in Emergency Departments

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Medical expulsive therapy (MET) for urinary stones in American emergency departments is underused despite evidence of its safety and efficacy, investigators have concluded.

John M. Hollingsworth, MD, and colleagues at the University of Michigan in Ann Arbor analyzed 2000-2006 data from the National Hospital Ambulatory Medical Care Survey. They determined MET use by the prescription for a calcium channel blocker or alpha blocker at ED visits for stones.

Although MET use increased over the study period—with the likelihood of being treated with MET doubling with each successive year—the overall prevalence of MET use was only 1.1%.

Previous research suggests that one in four stone patients treated with MET avoids stone surgery. If this is the case, the low prevalence of MET use in American emergency departments implies a missed opportunity to spare about 260,000 individuals annually from having to undergo stone surgery, the investigators reported in Urology (2009; published online ahead of print).

“Despite the growing body of evidence to support its safety and efficacy for promoting upper tract stone passage,” the authors wrote, “our analysis reveals the sluggish dissemination of MET into the broader medical community. The observed underuse represents a block in the translation of clinical science into practice and raises a quality of care concern.”

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