MP55-01 CONTEMPORARY PRACTICE PATTERNS IN VOIDING CYSTOURETHROGRAM (VCUG) USE: THE IMPACT OF EVIDENCE-BASED GUIDELINES

Abstract

You have accessJournal of UrologyPediatrics: Urinary Tract Infection and Vesicoureteral Reflux1 Apr 2016MP55-01 CONTEMPORARY PRACTICE PATTERNS IN VOIDING CYSTOURETHROGRAM (VCUG) USE: THE IMPACT OF EVIDENCE-BASED GUIDELINES Linda Lee, Armando Lorenzo, Rakan Odeh, Paul Bowlin, Jeffrey Traubici, and Martin Koyle Linda LeeLinda Lee More articles by this author , Armando LorenzoArmando Lorenzo More articles by this author , Rakan OdehRakan Odeh More articles by this author , Paul BowlinPaul Bowlin More articles by this author , Jeffrey TraubiciJeffrey Traubici More articles by this author , and Martin KoyleMartin Koyle More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.592AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While VCUG is a widely accepted test, it is invasive and associated with radiation exposure. Most cases of VUR are low-grade and unlikely to be associated with acquired renal scarring. In an effort to select patients at greatest risk, the American Academy of Pediatrics (AAP) published revised guidelines on urinary tract infections in children ages 2 to 24 months in 2011. In this project, we examine contemporary practice patterns and indications for VCUG, in the context of newer evidence-based guidelines. We hypothesize that the rate of VCUGs has declined over time, which may be geared towards detection of more clinically significant VUR. METHODS All VCUGs performed at our institution from 2008 to present were identified. Follow-up VCUGs were excluded. Further data collection was performed for patients whom had a VCUG in the first six months of 2009 and 2014, in order to obtain representative data before and after publication of the 2011 AAP guidelines. Medical records for these patients were retrospectively reviewed for baseline patient characteristics, indication for VCUG, type of ordering physician, prior history of febrile UTIs, renal and bladder ultrasound and renal scan findings. RESULTS From January 2008 to August 2014, a total of 8214 VCUGs were performed at our institution. The annual number of VCUGs has declined steadily over time. We then compared the 6-month periods from January to June (inclusive) in 2009 and 2014, which identified 634 and 292 VCUGs, respectively. There were no statistically significant differences in mean age or gender between both groups. Although there was a decline in VCUGs in 2014, the rate of VCUGs performed for UTIs remained the same (65% in 2009 and 64% in 2014, p=0.88). In both groups, pediatric urologists comprised the minority of ordering physicians (14% in 2009 and 16% in 2014, p=0.48). While there is no statistically significant difference in detection rate of VUR from 2009 to 2014 (31% vs. 37%, p=0.07), there has been a three-fold increase in diagnosis of high grade (IV-V) VUR in 2014, compared to 2009 (10.2% vs 3.2%, p=0.0001). CONCLUSIONS There has been an overall trend towards fewer VCUGS being performed at our institution, even prior to the 2011 AAP guidelines. While the majority of VUR cases detected remain low-grade, there has been a higher detection rate of high-grade (IV-V) VUR in 2014, compared to 2009. This may be a reflection of changing practice patterns of ordering physicians. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e735 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Linda Lee More articles by this author Armando Lorenzo More articles by this author Rakan Odeh More articles by this author Paul Bowlin More articles by this author Jeffrey Traubici More articles by this author Martin Koyle More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...