Login to Access Video or Poster Abstract: MP61-07
Sources of Funding: Bomalaski Scholarship: Institutional grant to help support urology residents and pediatric urology fellows

Introduction

The evaluation of children with a febrile urinary tract infection (UTI) has continued to evolve. A significant paradigm shift occurred in 2011, when the American Academy of Pediatrics (AAP) Guidelines on UTI diagnosis and evaluation recommended against voiding cystourethrogram (VCUG) after a first-time diagnosis of febrile UTI in children aged 2 to 24 months. The objective of this study was to assess national trends in VCUG utilization over the past 15 years.

Methods

We performed analysis using Optum Labs Data Warehouse administrative claims data from January 2001 - June 2015. Our cohort included all children age ≤ 10 yrs who underwent VCUG for UTI, vesicoureteral reflux, or pyelonephritis. We excluded patients with co-existing diagnoses that involves VCUG as part of standard evaluation. Multiple group interrupted time series analysis (ITSA) with two intervention periods was used to evaluate the impact of the 2011 AAP Guideline on standardized rates of VCUG (Linden, Liden & Yarnold). We designated ages 0 - 2 yr as treatment and 6 - 10 yr as control groups.

Results

There were 49,311 children identified in our cohort. Post AAP Guideline VCUG rates were significantly decreased compared to pre-intervention VCUG rates for both the 0-2 and 6-10 yr groups (p = <0.0001 and 0.009, respectively). From 2011 to 2015, absolute VCUG utilization rates decreased from 115.8 to 56.5 per 100,000. There was a significant decreasing trend in VCUG utilization rates in the post AAP period (2nd quarter of 2011 - 2nd quarter of 2015) for both age groups (p = <0.0001 and <0.0001, respectively). We also identified a significant decrease in VCUG utilization rates between periods 2001 - 2007 and 2007 - 2011 for both age groups (p = <0.0001 and <0.0001, respectively).

Conclusions

There was a significant reduction in VCUG utilization rates following publication of the 2011 AAP Guidelines. We also observed a significant decrease in VCUG utilization rates in 2007, the year in which the National Institute for Health and Clinical Excellence (NICE) UTI Guidelines recommended the &[Prime]top-down approach&[Prime] and against routine VCUG testing after febrile UTI. How these changes impacted VUR diagnosis, rates of pyelonephritis, and overall healthcare costs remains to be answered.

Funding

Bomalaski Scholarship: Institutional grant to help support urology residents and pediatric urology fellows