Underuse of 24-hour urine collection among children with incident urinary stones: a quality-of-care concern?

OBJECTIVE

To determine the prevalence of 24-hour urine collection among first-time pediatric stone formers and investigate factors associated with its use.

MATERIALS AND METHODS

Using data from the MarketScan Commercial Claims and Encounters Database (2002-2006), children presenting to the emergency department with an incident episode of upper urinary tract stone disease were identified through a diagnosis code-based algorithm. The number of patients performing a 24-hour urine collection within 6 months of this encounter was calculated. Temporal trends in the prevalence of use were assessed. We fitted multivariate logistic regression models to examine factors associated with testing.

RESULTS

In total, 1848 children presented with an incident upper tract stone, of which 12.0% submitted a 24-hour urine collection. This percentage remained stable over the study period. Testing was more common among younger patients (P <.001) and those who visited urologists (P <.001) or nephrologists (P <.001). The odds of testing were nearly 4-fold or 7-fold higher if the patient saw a urologist (odds ratio, 3.99; 95% confidence interval, 2.83-5.62) or a nephrologist (odds ratio, 7.00; 95% confidence interval, 3.95-12.41), respectively.

CONCLUSION

Despite rates of stone recurrence, 24-hour urine collection appears to be underused among children. Efforts to increase its use are therefore likely to benefit pediatric patients with urinary stone disease.