Jacobson Deborah L, Shannon Rachel, Cheng Earl Y, Green Jared R, Rigsby Cynthia K, Schroeder Sangeeta K, Malhotra Neha R, Rosoklija Ilina, Holl Jane L, Johnson Emilie K
Department of Urology, Northwestern University, Chicago, IL; Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Urology. 2019 Apr;126:180-186. doi: 10.1016/j.urology.2018.12.044. Epub 2019 Feb 6.
To evaluate rates of guideline adherence and associations with voiding cystourethrogram result. The American Academy of Pediatrics guidelines recommend voiding cystourethrogram after abnormal renal ultrasound or 2 febrile urinary tract infections. It is unclear whether guideline adherence increases vesicoureteral reflux detection. Additionally, guidelines targeting children 2-24 months are often applied to other ages.
Children undergoing voiding cystourethrogram from January 2012 to December 2013 at 1 institution were retrospectively reviewed. Children with known genitourinary abnormalities were excluded. The primary outcome was guideline adherence. Univariate and multivariate analyses were performed. Subgroup analysis of children 2-24 months was completed.
Voiding cystourethrograms from 365 children were included in the primary analysis, including 187 (51.2%) aged 2-24 months. Overall, 60.3% of voiding cystourethrograms were ordered in accordance with the guidelines. Urologists/nephrologists were more likely to adhere to ordering guidelines than pediatricians/others (76.4% vs 51.7%, odds ratio 3.0 [1.9-4.9], P <.001). Subgroup analysis in children 2-24 months revealed similar findings (76.4% vs 51.5%, odds ratio 3.0 [1.5-6.2], P = .002). Voiding cystourethrograms were abnormal in 31.8% overall and 26.2% aged 2-24 months. Guideline adherence was associated with increased likelihood of abnormal voiding cystourethrogram among all children (P = .02), but not among children 2-24 months (P = .95). Older age, white race, and guideline adherence remained significantly associated with abnormal voiding cystourethrogram in a multiple logistic regression model.
Guideline adherence was more likely among urologists/nephrologists than pediatricians/others and was not associated with abnormal voiding cystourethrogram among children 2-24 months. Multicenter evaluation is necessary to determine if ordering recommendations should be revised.
评估指南遵循率及其与排尿性膀胱尿道造影结果的相关性。美国儿科学会指南建议在肾脏超声检查异常或发生2次发热性泌尿道感染后进行排尿性膀胱尿道造影。目前尚不清楚遵循指南是否会增加膀胱输尿管反流的检出率。此外，针对2至24个月儿童的指南常被应用于其他年龄段的儿童。
对2012年1月至2013年12月在1家机构接受排尿性膀胱尿道造影的儿童进行回顾性研究。排除已知存在泌尿生殖系统异常的儿童。主要结局指标为指南遵循情况。进行单因素和多因素分析。完成了对2至24个月儿童的亚组分析。
365名儿童的排尿性膀胱尿道造影纳入了主要分析，其中187名（51.2%）年龄在2至24个月。总体而言，60.3%的排尿性膀胱尿道造影是按照指南进行安排的。与儿科医生/其他医生相比，泌尿科医生/肾病科医生更有可能遵循安排指南（76.4%对51.7%，优势比3.0[1.9 - 4.9]，P<.001）。对2至24个月儿童的亚组分析得出了类似结果（76.4%对51.5%，优势比3.0[1.5 - 6.2]，P = .002）。总体上31.8%的排尿性膀胱尿道造影结果异常，2至24个月儿童中这一比例为26.2%。在所有儿童中，遵循指南与排尿性膀胱尿道造影结果异常的可能性增加相关（P = .02），但在2至24个月儿童中并非如此（P = .95）。在多因素逻辑回归模型中，年龄较大、白人种族和遵循指南仍然与排尿性膀胱尿道造影结果异常显著相关。
与儿科医生/其他医生相比，泌尿科医生/肾病科医生更有可能遵循指南，且在2至24个月儿童中，遵循指南与排尿性膀胱尿道造影结果异常无关。需要进行多中心评估以确定是否应修订安排建议。
