Department of Pediatric Urology, Children's Hospital Colorado, Division of Urology, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.
Department of Pediatric Urology, Rady Children's Hospital of San Diego, Department of Urology, University of California San Diego School of Medicine, San Diego, California.
Urology. 2014 May;83(5):1135-8. doi: 10.1016/j.urology.2013.11.011. Epub 2014 Jan 4.
To identify geographic variability in the imaging of infants with congenital hydronephrosis at initial pediatric urologic evaluation.
We performed a retrospective review of infants aged ≤ 12 months with congenital hydronephrosis seen as new patients from October 2010 to September 2011 at 3 regionally diverse pediatric urology practices: University of Virginia Hospital, Rady Children's Hospital, and Children's Hospital Colorado. Primary outcomes measured were the type and number of tests ordered at initial evaluation. Independent variables collected included the following: patient age, location, and initial ultrasound findings. Ultrasound findings were manually extracted from the attending pediatric urologist's clinic note. All other data were automatically extracted from the electronic medical record. Proportions were analyzed using Pearson's goodness of fit and Fisher exact tests. Medians were compared using the Kruskal-Wallis test.
Two hundred forty-one patients met the study criteria. Median patient age was 2 months and did not differ across sites. Most patients (64.7%) had Society for Fetal Urology grade 0-2 hydronephrosis; prevalence of high-grade hydronephrosis varied across sites (P = .002). Use of voiding cystourethrography also varied across sites (17.6%-88.9%); this difference persisted when controlling for age and hydronephrosis grade (P <.05). Use of other imaging studies did not significantly differ across sites.
Use of screening voiding cystourethrography for infants with congenital hydronephrosis varies across practices. This variation persists when controlling for differences in age and ultrasound findings, suggesting that regional differences in patient demographics, provider/parental preferences, or referral patterns might contribute to practice variations in the evaluation of these patients.
确定在儿科泌尿科初次评估患有先天性肾积水的婴儿的影像学表现的地域差异。
我们对 2010 年 10 月至 2011 年 9 月在 3 个地区多样化的儿科泌尿科就诊的年龄≤12 个月的先天性肾积水新患者进行了回顾性研究：弗吉尼亚大学医院、Rady 儿童医院和科罗拉多儿童医院。主要结局指标为初始评估时所开检查的类型和数量。收集的独立变量包括：患者年龄、位置和初始超声检查结果。超声检查结果从主治儿科泌尿科医生的诊所记录中手动提取。所有其他数据均从电子病历中自动提取。使用 Pearson 拟合优度和 Fisher 精确检验分析比例。使用 Kruskal-Wallis 检验比较中位数。
241 名患者符合研究标准。患者的中位年龄为 2 个月，各地点之间无差异。大多数患者（64.7%）存在胎儿泌尿科协会分级 0-2 级的肾积水；高分级肾积水的患病率在各地点之间存在差异（P=0.002）。排尿性膀胱尿道造影的使用在各地点之间也存在差异（17.6%-88.9%）；当控制年龄和肾积水分级时，这种差异仍然存在（P<0.05）。其他影像学检查的使用在各地点之间无显著差异。
在患有先天性肾积水的婴儿中，筛查性排尿性膀胱尿道造影的使用在各实践中存在差异。当控制年龄和超声检查结果的差异时，这种差异仍然存在，这表明患者人群、提供者/父母的偏好或转诊模式的区域差异可能导致这些患者评估的实践差异。
