Open Access

ARTICLE

Discharge materials provided to patients with kidney stones in the emergency department may be a source of misinformation

Kevan M. Sternberg¹, Andrew Pham¹, Theodore Cisu¹, Marissa L. Kildow², Kristina L. Penniston²

1 University of Vermont Medical Center, Burlington, Vermont, USA
2 University of Wisconsin School of Medicine and Public Health, Urology, Madison, Wisconsin, USA
Address correspondence to Dr. Kevan M. Sternberg, University of Vermont Medical Center, 111 Colchester Avenue, Burlington, VT 05401 USA

Canadian Journal of Urology 2018, 25(6), 9585-9590.

Abstract

Introduction: Renal colic is commonly seen in the emergency department (ED), where the focus is on diagnosis and symptom control. Educational materials are sometimes provided upon discharge; however, no standard content has been established. We characterized the educational materials given to patients reporting to EDs in different regions across the U.S. for symptomatic kidney stones, specifically evaluating disease-specific information, symptom management, prevention strategies including dietary recommendations (DRs), and patient follow up plans.
Materials and methods: Generic discharge instructions for patients presenting to EDs with renal colic were obtained from community hospitals and academic medical centers between October 2016 and November 2017. Hospitals were called directly. If the same discharge instructions were used by more than one hospital, each was included in our analysis. We assessed the different types of information provided with a focus on stone prevention and DRs by characterizing them into specific nutritional categories.
Results: Of 266 hospitals contacted, 79 provided discharge instructions. Of these, 51 (65%) provided some information on diet. While most recommended higher fluid intake, almost 40% endorsed unnecessary fluid restrictions. Recommendations to reduce protein and oxalate intake were common, but erroneous information for both was given. Nearly 1 in 5 EDs recommended lower calcium intake. Less than 30% of EDs mentioned that stones can have different compositions or causes. Less than 30% referenced consultation with a registered dietitian nutritionist (RDN) or that dietary approaches to stone prevention are optimally individualized. Only 9 summaries recommended urologic follow up.
Conclusions: Many ED discharge materials contain DRs for stone prevention. These recommendations can be inaccurate and/or inappropriate. Advice on diet and stone prevention is more appropriately addressed in the outpatient setting when more data (stone composition, serum and urine parameters) and expert consultants are available.

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