362 Emergency Physician Intrapenile Injection for Priapism Significantly Reduces the Need for Bedside Urological Consultation

Priapism is a sporadic disease seen in the emergency department (ED). It requires prompt evaluation and treatment to avoid potentially significant sequelae. Treatment of this disease is highly variable and often performed by specialist rather than the treating emergency physician. To determine the treatment modalities used for patients presenting to the ED with priapism and whether any specific techniques reduce the need for bedside urological consult. Retrospective cohort study utilizing an electronic ED database. Individual patient charts were extracted using the final ICD9 diagnosis for priapism over a 2-year period (June 2012 to June 2014). Enrolling hospitals (N=15) represent both urban/suburban and academic/community settings. All charts were de-identified and subsequently reviewed for predetermined data points by blinded study personnel. Patients were excluded if the diagnosis was determined not to be priapism or for chart unavailability. Pediatrics was defined as being < 21 years of age. Statistics: Fisher’s Exact Test, with a predetermined significant P < .05, two tailed. Study was approved by the IRB. During the study period 236 patients had the final diagnosis of priapism and 222 fit inclusion criteria. Exclusions: 8 for chart unavailability and 6 with non-priapism diagnosis. Eighty-five percent (N=188) were discharged. Seven percent (N=16) required an operative procedure. Sickle cell patients comprise 20% (N=45) oatients. Median age overall was 39 years (IQR 22-52 years). Only 4% (N= 9) of patients fit criteria for pediatric. Treatment modality utilized: Adrenergic medication 63% (N=140), intrapenile injection 55% (N=122), opioids 49% (N=104), cavernous drainage 29% (N=64), and exchange transfusion (N=0). Urology was consulted in 77% (N=170) of patients. Urology ED bedside evaluation/treatment occurred in 52% (N=115). Of the122 intrapenile injections, urology performed a total of 80 (56%) injections. Urology also performed 70% (N=45) of the cavernous drainages. Mean turnaround time for those undergoing urological injection/aspiration was 301 (SD 148) minutes versus those undergoing emergency physician penile injection/aspiration was 289 (SD 131). Of patients who underwent injections performed by ED attendings only 11 required in-house ED urology consultations while 104 patients who did not undergo ED attending injections required urology bedside consults (difference of proportions -0.37 95% CI -0.51 to -0.24 (P < .001). Combination of ED IV adrenergic therapy, IV normal saline, opioids and/or injection by ED attending showed no difference in need for urology in-house consultation (difference in proportion 0.023 95% CI -0.14 to 0.19). Bedside emergency physician intrapenile injection for priapism significantly reduces the need for bedside urological consults, while other treatment modalities do not.