To identify patient and facility characteristics associated with primary definitive treatment of uncomplicated ureteral stones presenting to the emergency department (ED) vs decompression with ureteral stent or nephrostomy tube with plan for interval treatment.

Using the Healthcare Cost & Utilization Project Nationwide Emergency Department Sample, we identified all ED encounters for adults with primary diagnosis of ureteral stone between 2016-2019. Patients with infection or acute kidney failure were excluded. We fit a weighted multilevel logistic regression model to account for individual and hospital weights and included a random intercept to account for clustering by hospital.

Of the 1,253,000 ED encounters, 86% underwent no surgical intervention. Of the remaining 93,000, 43% (n = 35,724) underwent decompression alone while 57% (n = 47,109) underwent definitive treatment. On multivariable analysis, older patient age, higher patient Elixhauser comorbidity score, presentation on a weekend day, earlier year of ED visit (2016 vs 2019), and presenting to a hospital located in the Northeast US were all associated with a lower likelihood of definitive stone management with upfront ureteroscopy. Alternatively, patients in the highest income quartile were more likely to undergo definitive stone treatment compared with patients in the lowest.

Patient and facility characteristics predicted likelihood of receiving primary definitive stone treatment for uncomplicated ureteral stones. Given the increased burden on patients and systems associated with delayed treatment, further investigation is needed to ensure equitable and efficient resource allocation.