Division of Urology, Seattle Children's Hospital, Seattle, Washington.
University of Washington, Seattle, Washington.
J Surg Res. 2019 Feb;234:26-32. doi: 10.1016/j.jss.2018.08.047. Epub 2018 Sep 27.
Many families wish to have radiologic tests performed locally, especially when obtaining these tests in specialized pediatric centers would require long-distance travel with associated costs and inconveniences. The differential availability of specialized and common pediatric uroradiographic tests in rural and urban areas has not been described. We undertook this study to describe the availability of common radiographic tests ordered by pediatric urologists, and to identify disparities in the availability of radiographic tests between urban and rural locations.
We surveyed all freestanding hospitals in Washington State on the availability of flat-plate abdominal radiograph (AXR), renal-bladder ultrasounds (RBUS), voiding cystourethrograms (VCUG), MAG-3 renal scans, and nuclear cystograms (NC) for children, as well as testing restrictions, availability of sedation for urology tests, and presence of onsite radiologists. Rural and urban hospitals were compared on these characteristics.
The survey was completed by 74 of 88 institutions (84.1%); 17 (23.0%) were rural (population <2500), 32 (43.2%) were in urban clusters (population 2500-50,000), and 25 (33.8%) were in urban areas (population >50,000). Seventy-three (98.6%) institutions offered AXR, 68 (91.9%) offered RBUS, 44 (59.5%) offered VCUG, 26 (35.1%) offered MAG-3, and 15 (20.3%) offered NC to children. All urban and most (16/17; 94.1%) rural institutions had shareable digital imaging capability. AXR (100% versus 96%, P = 0.88) and RBUS (70.6% versus 96%, P = 0.15) availability was similar in rural and urban settings, whereas VCUG (11.8% versus 72%, P = 0.001), MAG-3 (5.9% versus 60%, P = 0.006), and NC (0% versus 44%, P = 0.017) were more commonly available in urban settings. Fewer rural hospitals employed full-time, in-house radiologists (35.3% versus 96%, P < 0.0001) or offered sedation (6.3% versus 36%, P = 0.01) for testing, but an equal proportion had age restrictions on the tests offered (40% versus 17.6%, P = 0.50). Fellowship-trained pediatric radiologists (0% versus 16%, P = 0.39) and child life specialists (0% versus 20%, P = 0.28) worked exclusively in urban settings. Most hospitals offering specialized radiographic tests (VCUG: 90.9%; P < 0.0001 and MAG-3: 92.3%; P = 0.002) had onsite radiologists.
The geographically widespread availability of AXR and RBUS may represent an opportunity to offer families care closer to home, realizing cost and time savings. Anxious children and those requiring more specialized studies may benefit from referral to urban centers. The lack of rural radiologists may be an actionable barrier to availability of specialized radiology testing.
许多家庭希望在当地进行放射学检查，特别是在专门的儿科中心进行这些检查需要长途旅行，费用和不便。农村和城市地区儿科泌尿科医生常用和特殊的泌尿科放射学检查的差异尚未描述。我们进行了这项研究，以描述儿科泌尿科医生开的常用放射学检查的可用性，并确定城乡放射学检查可用性之间的差异。
我们对华盛顿州所有独立医院进行了调查，以了解儿童平板腹部 X 光片（AXR）、肾脏膀胱超声（RBUS）、排尿性膀胱尿道造影（VCUG）、MAG-3 肾脏扫描和核膀胱造影（NC）的可用性，以及检查限制、泌尿科检查的镇静可用性以及现场放射科医生的存在。比较了农村和城市医院的这些特征。
共有 88 家机构中的 74 家（84.1%）完成了调查；17 家（23.0%）为农村（人口<2500），32 家（43.2%）为城市集群（人口 2500-50000），25 家（33.8%）为城市地区（人口>50000）。73 家（98.6%）机构为儿童提供 AXR，68 家（91.9%）提供 RBUS，44 家（59.5%）提供 VCUG，26 家（35.1%）提供 MAG-3，15 家（20.3%）提供 NC。所有的城市和大多数（17/17；94.1%）农村机构都有可共享的数字成像能力。农村和城市地区的 AXR（100%对 96%，P=0.88）和 RBUS（70.6%对 96%，P=0.15）可用性相似，而 VCUG（11.8%对 72%，P=0.001）、MAG-3（5.9%对 60%，P=0.006）和 NC（0%对 44%，P=0.017）在城市地区更为常见。农村医院的全职内部放射科医生（35.3%对 96%，P<0.0001）或提供镇静（6.3%对 36%，P=0.01）的比例较低，但提供的检查年龄限制相同（40%对 17.6%，P=0.50）。接受过儿科放射学专业培训的放射科医生（0%对 16%，P=0.39）和儿童生活专家（0%对 20%，P=0.28）仅在城市地区工作。提供特殊放射学检查的大多数医院（VCUG：90.9%；P<0.0001 和 MAG-3：92.3%；P=0.002）都有现场放射科医生。
AXR 和 RBUS 在地理上的广泛可用性可能为家庭提供离家更近的护理机会，实现成本和时间节省。焦虑的儿童和需要更专业研究的儿童可能会受益于转诊到城市中心。农村放射科医生的缺乏可能是影响特殊放射学检查可用性的一个可采取的障碍。
