FINDINGS
According to an examination of posts on Reddit, the pandemic has had a significant effect on the management of kidney stone disease. Researchers from the department of urology at the David Geffen School of Medicine at UCLA used computational analysis and other techniques to explore unfiltered discussions related to kidney stones in real time on the website’s discussion forums.
The investigators found that patients’ decision-making about how and when to seek treatment for kidney stones was driven by logistical barriers and patients’ reluctance to risk exposure to COVID-19 in health care facilities. Over a quarter of Reddit users who reported their stone sizes opted for conservative at-home treatment even when clinical guidelines would have suggested that they needed care from a medical professional. People reported on the site that they often held off on visiting an emergency room until they had larger stones, often creating serious additional health risks.
And, based on Reddit posts in which users mentioned the sizes of their kidney stones, the average size of stones at the time they saw a medical professional was 10.5 millimeters during the pandemic, up from an average of 5.1 millimeters for those on the discussion board before the pandemic. There also was a threefold increase in the number of discussions on the website about using opioids at home to control symptoms from kidney stones during the pandemic versus before the pandemic.
BACKGROUND
About 11% of men and 6% of women in the U.S. have kidney stones at least once during their lives. Due to public health precautions during the COVID-19 pandemic, the number of in-person visits to doctors or hospitals is lower, and many surgical procedures have been delayed or cancelled. The decision to seek medical treatment typically comes from the patient, rather than their doctor.
METHOD
Researchers combed through a Reddit discussion board on the topic of kidney stones, r/KidneyStones, which has more than 4,000 active users. They looked at posts three months before and after pandemic restrictions went into effect.
Investigators then processed discussions to identify factors driving patients’ decision-making regarding treatment for their kidney stones and used a technique called natural language processing to identify how subtle or overt changes in word choice may have been augmented during the pandemic. Finally, they examined whether non-emergency visits to health care facilities, the severity of kidney stone disease, and patients’ treatment preferences changed during the pandemic.
IMPACT
Throughout the COVID-19 pandemic, there have been discussions across the health care field about how public health restrictions have influenced patients’ decisions to seek treatment for other, unrelated conditions. As with other research on how pandemics can affect health care delivery, researchers hope to learn more about patient’s emergency department visits and their treatment preferences for the stone disease.
AUTHORS>
The paper’s lead authors are Tommy Jiang, a second-year medical student at the David Geffen School of Medicine, and UCLA urology residents Dr. Vadim Osadchiy and Dr. James Weinberger. The senior authors are UCLA urology assistant clinical professor Dr. Sriram Eleswarapu and associate clinical professor Dr. Jesse Mills.
JOURNAL
The findings are published in the journal Endourology.
