Variations in Adherence to American Urological Association Guidelines for Followup of Children with Vesicoureteral Reflux.

Abstract

Although the American Urological Association has established clinical guidelines for evaluation of vesicoureteral reflux in children, adoption of these guidelines has not been measured. The purpose of this study was to assess adherence to American Urological Association recommendations for annual followup in a multicenter cohort of children with vesicoureteral reflux. We conducted a retrospective cohort study utilizing data in the Epic electronic health record across 3 pediatric urology practices. Patients were included if they had an initial clinic visit between January 1, 2010 and December 31, 2016, were under the age of 11 years and had a diagnosis of vesicoureteral reflux. Data regarding patient demographics, initial and 1-year followup evaluation with vital signs, urinalysis and ultrasound were captured. Kruskal-Wallis and chi-square analyses were used for univariable analyses. Logistic regression models were created for multivariable analyses. We identified 1,576 patients. Most patients were female (68%), Hispanic or nonwhite (52%) and treated with antibiotic prophylaxis (55.7%). Initial evaluation with vital signs and urinalysis varied significantly across sites (p <0.05). In patients who had a 1-year followup visit (974) followup vital signs and urinalysis varied by site (p <0.001). Followup ultrasound did not vary by site. Using multivariate analysis, followup measures were associated with location and measures obtained at initial evaluation (p <0.05). Additionally, followup ultrasound and urinalysis were more likely in children on antibiotic prophylaxis (p <0.05). We found significant variations in adherence to American Urological Association recommendations for annual followup of children with vesicoureteral reflux. Further work is needed to understand the impact of these variations on patient outcomes.