Adherence to the 2011 American Academy of Pediatrics Urinary Tract Infection Guidelines for Voiding Cystourethrogram Ordering by Clinician Specialty

Deborah L. Jacobson, Rachel Shannon, Earl Y Cheng, Jared R Green, Cynthia K Rigsby, Sangeeta Kaur Gill Schroeder, Neha R. Malhotra, Ilina Rosoklija, Jane Louise Holl, Emilie Katherine Johnson*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Objective: 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. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)180-186
Number of pages7
JournalUrology
Volume126
DOIs
StatePublished - Apr 1 2019

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Urinary Tract Infections
Guideline Adherence
Guidelines
Pediatrics
Urogenital Abnormalities
Logistic Models
Odds Ratio
Vesico-Ureteral Reflux
Fever
Multivariate Analysis
Kidney

ASJC Scopus subject areas

  • Urology

Cite this

@article{0d8d5a830df74910ac8cba62cf338901,
title = "Adherence to the 2011 American Academy of Pediatrics Urinary Tract Infection Guidelines for Voiding Cystourethrogram Ordering by Clinician Specialty",
abstract = "Objective: 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. Methods: 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. Results: 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. Conclusions: 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.",
author = "Jacobson, {Deborah L.} and Rachel Shannon and Cheng, {Earl Y} and Green, {Jared R} and Rigsby, {Cynthia K} and Schroeder, {Sangeeta Kaur Gill} and Malhotra, {Neha R.} and Ilina Rosoklija and Holl, {Jane Louise} and Johnson, {Emilie Katherine}",
year = "2019",
month = "4",
day = "1",
doi = "10.1016/j.urology.2018.12.044",
language = "English (US)",
volume = "126",
pages = "180--186",
journal = "Urology",
issn = "0090-4295",
publisher = "Elsevier Inc.",

}

Adherence to the 2011 American Academy of Pediatrics Urinary Tract Infection Guidelines for Voiding Cystourethrogram Ordering by Clinician Specialty. / Jacobson, Deborah L.; Shannon, Rachel; Cheng, Earl Y; Green, Jared R; Rigsby, Cynthia K; Schroeder, Sangeeta Kaur Gill; Malhotra, Neha R.; Rosoklija, Ilina; Holl, Jane Louise; Johnson, Emilie Katherine.

In: Urology, Vol. 126, 01.04.2019, p. 180-186.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Adherence to the 2011 American Academy of Pediatrics Urinary Tract Infection Guidelines for Voiding Cystourethrogram Ordering by Clinician Specialty

AU - Jacobson, Deborah L.

AU - Shannon, Rachel

AU - Cheng, Earl Y

AU - Green, Jared R

AU - Rigsby, Cynthia K

AU - Schroeder, Sangeeta Kaur Gill

AU - Malhotra, Neha R.

AU - Rosoklija, Ilina

AU - Holl, Jane Louise

AU - Johnson, Emilie Katherine

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Objective: 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. Methods: 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. Results: 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. Conclusions: 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.

AB - Objective: 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. Methods: 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. Results: 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. Conclusions: 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.

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