Fargason C A, Bronstein J M, Johnson V A
Department of Pediatrics, University of Alabama at Birmingham, USA.
Pediatrics. 1995 Oct;96(4 Pt 1):638-42.
Urinary tract infections (UTIs) occur commonly in children and may lead to substantial morbidity. Most experts recommend urine cultures for diagnosing UTIs in children. In addition, most experts recommend imaging studies in a portion of children diagnosed with UTIs.
The purpose of this study was to assess how rates of performance of urine cultures and imaging studies for children in the Alabama Medicaid program diagnosed with a UTI vary by patient demographics, provider characteristics, and service locations.
The study design was a retrospective review of Alabama Medicaid claims data. Children were included as UTI cases if they had a Medicaid claim for urinary tract infections during 1991, were continuously enrolled in Medicaid for that year, and were younger than 8 years of age. Claims were grouped into episodes of care, and episodes were assigned to a diagnosing physician. Physician locations were classified as rural, suburban, or urban using demographic data. Specific laboratory and imaging procedures were identified using CPT codes (Physician's Current Procedural Technology Codes, 4th Edition).
We identified 404 episodes of UTI occurring in 380 children. Only 47% of episodes were associated with claims for urine cultures. Claims for urine cultures were more frequently filed by pediatricians in urban locations. In the subset of 114 patients with multiple UTI episodes, only 68% had imaging studies specific for the urinary tract. Only 44% received both a voiding cystourethrogram and renal ultrasound.
Claims data suggest that physicians underuse urine cultures in diagnosing UTIs in Alabama pediatric Medicaid recipients. Urban-based pediatricians perform better than other types of physicians. Imaging studies are also used less frequently than is commonly recommended.
尿路感染（UTIs）在儿童中很常见，可能导致严重的发病情况。大多数专家建议通过尿培养来诊断儿童尿路感染。此外，大多数专家建议对部分诊断为UTIs的儿童进行影像学检查。
本研究的目的是评估阿拉巴马医疗补助计划中被诊断为UTIs的儿童进行尿培养和影像学检查的比例如何因患者人口统计学特征、医疗服务提供者特征和服务地点而有所不同。
本研究设计为对阿拉巴马医疗补助索赔数据进行回顾性分析。如果儿童在1991年有尿路感染的医疗补助索赔，当年持续参加医疗补助计划，且年龄小于8岁，则将其纳入UTIs病例。索赔被分组为护理事件，事件被分配给诊断医生。使用人口统计学数据将医生地点分类为农村、郊区或城市。使用CPT编码（《医师现行操作技术编码》第4版）识别特定的实验室和影像学检查程序。
我们识别出380名儿童发生的404次UTIs事件。只有47%的事件与尿培养索赔相关。城市地区的儿科医生更频繁地提交尿培养索赔。在114名有多次UTIs事件的患者子集中，只有68%进行了泌尿系统特异性影像学检查。只有44%接受了排尿性膀胱尿道造影和肾脏超声检查。
索赔数据表明，在阿拉巴马州儿科医疗补助受助者中，医生在诊断UTIs时未充分使用尿培养。城市儿科医生的表现优于其他类型的医生。影像学检查的使用频率也低于普遍建议的水平。
