Login to Access Video or Poster Abstract: MP61-16
Sources of Funding: 2016 AUA Data Grant

Introduction

Although the American Urologic Association (AUA) has established clinical guidelines addressing the evaluation of children with vesicoureteral reflux (VUR), the extent of adoption of these guidelines is unclear. The purpose of this study was to assess adherence to AUA recommendations for annual follow up of children with VUR and to identify demographic and clinical factors associated with increased adherence across multiple sites.

Methods

We conducted a multicenter cohort study utilizing data embedded in the Epic electronic health record (EMR) across three pediatric urology practices. Patients were included if they had been seen between 9/1/2015 and 2/28/2016, were age < 18 years, and had a diagnosis of VUR. Data regarding patient demographics, initial and one year follow up evaluation with vital signs, urinalysis (UA), and ultrasound (US) were captured. Chi-squared was used for univariate analyses and logistic regression models were created for univariate and multivariable analyses.

Results

837 patients were identified. Most patients were female (69%), white (67.2%), and non-Hispanic (61.5%) with a mean age of 2.3 years (st. dev. 3). Initial evaluation with vital signs and UA varied significantly across sites (p<0.001). In patients who had at least one year of follow up (n=439), follow up vital signs and US were associated with treatment with prophylaxis and age (p<0.01). Site was associated with follow up blood pressure (BP), height, and UA (p<0.001); US and weight did not vary by site. Initial evaluation was also associated with follow up BP, height, and UA (p<0.001). On multivariate analysis, location, initial evaluation with BP, treatment plan, and age remained significantly associated with follow up BP (all p<=0.02). Location and height at initial visit were associated with follow up height (p<0.001); similarly, location and UA at initial visit were associated with follow up UA (p<0.001). Weight and US did not seem to be associated with location but did vary by treatment plan (p<0.05).

Conclusions

We found significant variations in adherence to AUA recommendations for annual vital signs, US, and UA. While many of these appear to be based on site of care, follow up studies were also associated with patient age, initial evaluation, and treatment plan. Further work is needed to better understand the etiology of these variations and the role of additional clinical factors, such as VUR grade and renal impairment, on adherence to AUA recommendations for VUR.

Funding

2016 AUA Data Grant