1
|
Koyun Cezayir B, Yavascan Ö, Alaygut D, Demir BK, Mutlubas F, Arslansoyu Camlar S, Alparslan C, Soyaltin E, Ozgur S. A new recommendation for febrile urinary tract infection in children aged 2-24 months: Tepecik UTI Guideline-2. J Trop Pediatr 2022; 69:6982496. [PMID: 36625359 DOI: 10.1093/tropej/fmac109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIM Urinary tract infections (UTIs) represent a common febrile illness in infancy. The study compared two UTI guidelines in terms of number of imaging studies, presence of parenchymal damage and radiation exposure in patients with the first febrile UTI between 2 and 24 months of age. METHOD The results of Tepecik UTI Guideline-1 used until 2012 (Group 1, n = 105) were retrospectively compared with Tepecik UTI Guideline-2 (Group 2) used after 2013. In Group 1, urinary tract ultrasonography (US), dimercaptosuccinic acid (DMSA) and voiding cystourethrography (VCUG) were made in all patients. In Group 2, if the US result was abnormal, patients were evaluated with VCUG and DMSA. If the US was normal, only DMSA was performed. If the DMSA was abnormal, the VCUG was undergone (n: 43, 40.9%). RESULTS The abnormal VCUG detection rate was 69.2% in Group 1 and 30.8% in Group 2 (p = 0.09). Sensitivity and specificity of US in the diagnosis of vesicoureteral reflux (VUR) was 15.9% and 96.7% in Group 1 and 61.5% and 70.5% in Group 2, respectively. Abnormal DMSA findings were observed among 33.3% (Groups 1) and 66.7% (Groups 2) subjects, respectively (p > 0.05). The median radiation exposure (500 mrem) of patients in Group 1 was statistically significantly higher than those in Group 2 (200 mrem) (p < 0.001). CONCLUSION The VCUG should not be the first examination to be considered in such patients. We think that Tepecik UTI Guideline-2 reduces unnecessary invasive procedure and radiation exposure and not missed VUR in the management of children with UTI at 2-24 months. Needs prospective follow-up studies before considering this recommendation.
Collapse
Affiliation(s)
- Begüm Koyun Cezayir
- Department of Pediatrics, Health Sciences University, Tepecik Training and Research Hospital, Izmir 35180, Turkey.,Department of Pediatrics, Health Sciences University, Buca Seyfi Demirsoy Training and Research Hospital, Izmir 35390, Turkey
| | - Önder Yavascan
- Department of Pediatric Nephrology, Health Sciences University, Tepecik Training and Research Hospital, Izmir 35180, Turkey.,Faculty of Medicine, Department of Pediatric Nephrology, Istanbul Medipol University, Istanbul 34214, Turkey
| | - Demet Alaygut
- Department of Pediatric Nephrology, Health Sciences University, Tepecik Training and Research Hospital, Izmir 35180, Turkey
| | - Belde Kasap Demir
- Department of Pediatric Nephrology, Health Sciences University, Tepecik Training and Research Hospital, Izmir 35180, Turkey.,Faculty of Medicine, Department of Pediatric Nephrology, Katip Celebi University, Izmir 35180, Turkey
| | - Fatma Mutlubas
- Department of Pediatric Nephrology, Health Sciences University, Tepecik Training and Research Hospital, Izmir 35180, Turkey
| | - Secil Arslansoyu Camlar
- Department of Pediatric Nephrology, Health Sciences University, Tepecik Training and Research Hospital, Izmir 35180, Turkey
| | - Caner Alparslan
- Department of Pediatric Nephrology, Health Sciences University, Tepecik Training and Research Hospital, Izmir 35180, Turkey
| | - Eren Soyaltin
- Department of Pediatric Nephrology, Health Sciences University, Tepecik Training and Research Hospital, Izmir 35180, Turkey.,Department of Pediatric Nephrology, Health Sciences University Faculty of Medicine, Basaksehir Cam Sakura City Hospital, İstanbul 34488, Turkey
| | - Su Ozgur
- Department of Biostatistics and Medical Informatics, Ege University Faculty of Medicine, Izmir 35040, Turkey
| |
Collapse
|
2
|
Okatch H, Nkala B, Beltrami J, Poy E, Parmer D, Nkala J, Olawole F. Assessing the effect of four types of direct mail messages to promote the uptake of residential lead remediation funds. PUBLIC HEALTH IN PRACTICE 2022; 4:100321. [PMID: 36203491 PMCID: PMC9531283 DOI: 10.1016/j.puhip.2022.100321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To examine the efficacy of direct mailing using four types of messaging on promoting the uptake of residential lead remediation (RLR) funds in Lancaster, PA, USA. Study design We designed a quasi-experiment to assess the effect of 4 RLR messages sent to households in Lancaster, PA by direct mail between September and December 2020: a brief flyer (F); a detailed brochure + the flyer (BF); a health infographic + the flyer (IF); and an application form + the flyer (AFF). Methods Mailers were sent to addresses in four census tracts; each census tract received a different message. Both English and Spanish versions were sent. The outcomes were the event rate defined as the number of phone call inquiries received, and the number of applications received. The association between type of messaging and household type (owner-vs renter-occupied) was assessed using a chi square test. Results The event rates for the renter-occupied households were lower than for owner-occupied households, regardless of treatment. The event rates for renter-occupied households in the F, BF, IF and AFF groups were 0.00%, 0.35%, 0.12% and 0.18% respectively compared to 0.93%, 0.45%, 0.86% and 1.32% for homeowners. More applications were received from homeowners, and the event rate of the owner-occupied households was significantly different from that of renter-occupied homes (p-value = 0.001). Conclusions Event rates and applications received were higher for owner-occupied households than they were for renter-occupied households. Direct mailing of RLR information is feasible especially if households at high risk for lead poisoning are targeted.
Collapse
|
3
|
Lorenzo AJ, Rickard M, Santos JD. The role of bladder function in the pathogenesis and treatment of urinary tract infections in toilet-trained children. Pediatr Nephrol 2020; 35:1395-1408. [PMID: 30671629 DOI: 10.1007/s00467-019-4193-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/21/2018] [Accepted: 01/08/2019] [Indexed: 02/03/2023]
Abstract
Urinary tract infections (UTIs) are a common reason for referral to pediatric specialists and the risk profile of these children is influenced by age, sex, and underlying urinary tract abnormalities. UTIs in toilet-trained children represent a different entity than confirmed, febrile UTIs that occur in infants, impacted by suboptimal bladder habits, bladder dysfunction, constipation, or a combination of these factors. A comprehensive literature search was conducted using PubMed and MEDLINE and search terms included recurrent UTI, VUR, bladder and bowel dysfunction (BBD), constipation, lower urinary tract symptoms, and voiding dysfunction. Common presenting symptoms of UTI in children include fever (> 38 °C) with or without "traditional" lower urinary tract symptoms (LUTS) such as dysuria, malodorous urine, frequency, urgency, and incontinence. However, many infections in older children are afebrile episodes-consisting primarily of LUTS-which may or may not be confirmed with biochemical and/or microbiological evidence. Therefore, when evaluating toilet-trained children with recurrent UTIs, it is paramount to consider dysfunctional elimination as an underlying cause, diagnose, and treat it prior to indicating surgical options, even in the presence of VUR or other anatomical abnormalities. Although the impact of bladder function on the risk of infections is important, so is the accurate diagnosis and initial evaluation. This review article will focus on an often overlooked yet critical factor: the impact of bladder function, particularly for toilet-trained children, as well as the importance of implementing bladder training strategies, aggressive management of constipation, and pharmacological management as necessary.
Collapse
Affiliation(s)
- Armando J Lorenzo
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada. .,Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
| | - Mandy Rickard
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Joana Dos Santos
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| |
Collapse
|
4
|
Kim YJ, Cho BS, Lee J, Ryu H, Byun H, Yeon M, Park Y, Oh C, Jeon Y. The ABCs of Voiding Cystourethrography. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:101-118. [PMID: 36238127 PMCID: PMC9432100 DOI: 10.3348/jksr.2020.81.1.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/13/2019] [Accepted: 07/31/2019] [Indexed: 11/30/2022]
Abstract
Voiding cystourethrography (VCUG) demonstrates the anatomy of the urinary system and is used to detect the presence/absence of vesicoureteral reflux. It is the most important modality for urological fluoroscopic examination in children. For improved patient care, it is important to understand and perform VCUG appropriately. Therefore, an in-depth review of VCUG protocols and techniques has been presented herein. In addition, tips, tricks, and pitfalls associated with the technique have also been addressed.
Collapse
Affiliation(s)
- Yu Jin Kim
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Bum Sang Cho
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
- Department of Radiology, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Junghwan Lee
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Hyeonmi Ryu
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Honggwon Byun
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Miran Yeon
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Yeongtae Park
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Changhoon Oh
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Younghun Jeon
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
| |
Collapse
|
5
|
Ming JM, Lee LC, Chua ME, Zhu J, Braga LH, Koyle MA, Lorenzo AJ. Population-based trend analysis of voiding cystourethrogram ordering practices in a single-payer healthcare system before and after the release of evaluation guidelines. J Pediatr Urol 2019; 15:152.e1-152.e7. [PMID: 30718129 DOI: 10.1016/j.jpurol.2018.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 12/25/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION While voiding cystourethrogram (VCUG) is a widely-accepted test, it is invasive and associated with radiation exposure. Most cases of primary vesicoureteral reflux (VUR) are low-grade and unlikely to be associated with acquired renal scarring. To select patients at greatest risk, in 2011 the American Academy of Pediatrics (AAP) published guidelines for evaluation of children ages 2 - 24 months with urinary tract infections (UTIs). Similarly, in 2010 the Society for Fetal Urology (SFU) published guidelines for patients with hydronephrosis. Herein a prospectively-collected database was queried through the Institute of Clinical Evaluative Sciences (ICES), exploring trends in VCUG ordering within the Ontario Health Insurance Program (OHIP), which guarantees universal access to care. MATERIAL AND METHODS A dedicated ICES analyst extracted data on all patients younger than 18 years in Ontario, Canada, with billing codes for VCUG and ICD-9 codes for VUR, from 2004-2014. The baseline characteristics included patient age, gender, geographic region, specialty of ordering provider and previous diagnoses of UTI and/or antenatal hydronephrosis to determine the indication for ordering the test. Of these, patients were subsequently incurred OHIP procedure codes for endoscopic injection or ureteral reimplantation. Patients who had a VCUG in the setting of urethral trauma, posterior urethral valves, and neurogenic bladder were excluded. RESULTS AND DISCUSSION Trend analysis demonstrated that the total number of VCUGs ordered in the province has decreased over a decade (Figure 1), with a concurrent decrease in VUR diagnosis. On multivariate regression analysis, the decrease in VCUG ordering could not be explained by changes in population demographics or other baseline patient variables. Most VCUGs obtained per year were ordered by pediatricians or family physicians (mean 2,022+523.8), compared with urologists and nephrologists (mean 616+358.3). Interestingly, while the rate of VCUG requests decreased, the annual number of surgeries performed for VUR (endoscopic or open) did not show a significant reduction over time. CONCLUSIONS We present a large population-based analysis in a universal access to care system, reporting a decreasing trend in the number of cystograms and differences by primary care versus specialist providers. While it is reassuring to see practice patterns favorably impacted by guidelines, it is also encouraging to note that the number of surgeries has remained stable. This suggests that patients at risk continue to be detected and offered surgical correction. These data confirm previous institution-based assessments and affirm changes in VCUG ordering independent of variables not relevant to the healthcare system, such as the insurance status.
Collapse
Affiliation(s)
- J M Ming
- Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, Canada
| | - L C Lee
- Division of Urology, Department of Surgery, University of British Columbia, Canada
| | - M E Chua
- Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, Canada
| | - J Zhu
- Institute of Clinical Evaluative Sciences (ICES), Canada
| | - L H Braga
- Division of Urology, McMaster University, Canada
| | - M A Koyle
- Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, Canada
| | - A J Lorenzo
- Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, Canada.
| |
Collapse
|
6
|
Johnin K, Kobayashi K, Tsuru T, Yoshida T, Kageyama S, Kawauchi A. Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children. Int J Urol 2018; 26:160-171. [PMID: 30569659 DOI: 10.1111/iju.13881] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/14/2018] [Indexed: 12/24/2022]
Abstract
Voiding cystourethrography is the most important fluoroscopic examination in pediatric urology for the investigation of lower urogenital tract diseases, such as vesicoureteral reflux or urethral stricture. However, this invasive procedure imposes a significant burden on children and their parents, and recently there has been a paradigm shift in the diagnosis and treatment of vesicoureteral reflux. In the 2011 revision, the American Academy of Pediatrics guidelines on urinary tract infection recommended abandoning routine voiding cystourethrography after the first febrile urinary tract infection. In 2014, the randomized intervention for children with vesicoureteral reflux study recommended discontinuation of routine continuous antibiotic prophylaxis for vesicoureteral reflux. The time is now ripe to radically reconsider indications for voiding cystourethrography and the procedure itself.
Collapse
Affiliation(s)
- Kazuyoshi Johnin
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kenichi Kobayashi
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Teruhiko Tsuru
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tetsuya Yoshida
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Susumu Kageyama
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Akihiro Kawauchi
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga, Japan
| |
Collapse
|
7
|
Vereen RJ, Kogan BA, Feustel PJ. Local Trends in the Evaluation and Treatment of Urinary Tract Infections and Vesicoureteral Reflux in Children. UROLOGY PRACTICE 2017; 4:54-59. [PMID: 37592633 DOI: 10.1016/j.urpr.2016.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The management of urinary tract infection in children has changed in the last decade due to worries about antibiotic overuse, and the trauma and radiation of voiding cystourethrograms. We examined whether there has been a change in the management of pediatric urinary tract infection in our practice. METHODS We reviewed billing records from 2005 to 2013 to determine the number of voiding cystourethrograms performed as well as the number of operations (open and endoscopic) for vesicoureteral reflux. We also determined the number of patients seen in the office for urinary tract infection or vesicoureteral reflux and hospital admissions for urinary tract infection or pyelonephritis. RESULTS There was a dramatic decrease in the number of voiding cystourethrograms performed from 907 in 2005 to 216 in 2013. The number of operations for vesicoureteral reflux increased to a peak of 73 in 2007 and decreased to 17 in 2013. Office visits for urinary tract infection or vesicoureteral reflux were unchanged from 2006 to 2013 (602 and 470, respectively). Pediatric hospitalizations for urinary tract infection trended only slightly upward from 2005 to 2013 (71 and 84, respectively). CONCLUSION Our results demonstrate a marked decrease in the diagnosis and treatment of vesicoureteral reflux in the last decade with no significant change in the number of patients seen for urinary tract infection. If confirmed nationally, this has major clinical, educational and health care quality improvement implications.
Collapse
|
8
|
Lee LC, Lorenzo AJ, Odeh R, Falkiner M, Lebarron DA, Traubici J, Mann E, Bowlin PR, Koyle MA. Contemporary Practice Patterns of Voiding Cystourethrography Use at a Large Tertiary Care Center in a Single Payer Health Care System. J Urol 2016; 197:951-956. [PMID: 27593475 DOI: 10.1016/j.juro.2016.08.102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE Voiding cystourethrogram involves radiation exposure and is invasive. Several guidelines, including the 2011 AAP (American Academy of Pediatrics) guidelines, no longer recommend routine voiding cystourethrogram after the initial urinary tract infection in children. The recent trend in voiding cystourethrogram use remains largely unknown. We examined practice patterns of voiding cystourethrogram use and explored the impact of these guidelines in a single payer system in the past 8 years. MATERIALS AND METHODS We identified all voiding cystourethrograms performed at a large pediatric referral center between January 2008 and December 2015. Patients 2 to 24 months old who underwent an initial voiding cystourethrogram for the diagnosis of a urinary tract infection in the first 6 months of 2009 and 2014 were identified. Medical records were retrospectively reviewed. RESULTS During the study period 8,422 voiding cystourethrograms were performed and the annual number declined over time. In the pre-AAP and post-AAP cohorts 233 and 95 initial voiding cystourethrograms were performed, respectively. While there was no statistically significant difference in the vesicoureteral reflux detection rate between 2009 and 2014 (37.3% vs 43.0%, p = 0.45), there was a threefold increase in high grade vesicoureteral reflux in 2014 (2.6% vs 8.4%, p = 0.03). CONCLUSIONS A clear trend toward fewer voiding cystourethrograms was noted at our institution. This decrease started before 2011 and cannot be attributed to the AAP guidelines alone. While most detected vesicoureteral reflux remains low grade, there was a greater detection rate of high grade vesicoureteral reflux in 2014 compared to 2009. This may reflect a favorable impact of a more selective approach to obtaining voiding cystourethrograms.
Collapse
Affiliation(s)
- Linda C Lee
- Division of Urology, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Armando J Lorenzo
- Division of Urology, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rakan Odeh
- Division of Urology, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Falkiner
- Department of Radiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Dawn-Ann Lebarron
- Department of Radiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey Traubici
- Department of Radiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Erika Mann
- Department of Radiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Paul R Bowlin
- Division of Urology, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Martin A Koyle
- Division of Urology, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
9
|
Lee LC, Lorenzo AJ, Koyle MA. The role of voiding cystourethrography in the investigation of children with urinary tract infections. Can Urol Assoc J 2016; 10:210-214. [PMID: 27713802 DOI: 10.5489/cuaj.3610] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Urinary tract infections (UTIs) represent a common bacterial cause of febrile illness in children. Of children presenting with a febrile UTI, 25-40% are found to have vesicoureteral reflux (VUR). Historically, the concern regarding VUR was that it could lead to recurrent pyelonephritis, renal scarring, hypertension, and chronic kidney disease. As a result, many children underwent invasive surgical procedures to correct VUR. We now know that many cases of VUR are low-grade and have a high rate of spontaneous resolution. The roles of surveillance, antibiotic prophylaxis, endoscopic injection, and ureteral reimplantation surgery also continue to evolve. In turn, these factors have influenced the investigation of febrile UTIs. Voiding cystourethrography (VCUG) is the radiographic test of choice to diagnose VUR. Due to its invasive nature and questionable benefit in many cases, the American Academy of Pediatrics (AAP) no longer recommends VCUG routinely after an initial febrile UTI. Nevertheless, these guidelines pre-date the landmark Randomized Intervention of Children with Vesicoureteral Reflux (RIVUR) trial and there continues to be controversy regarding the diagnosis and management of VUR. This paper discusses the current literature regarding radiographic testing in children with febrile UTIs and presents a practical risk-based approach for deciding when to obtain a VCUG.
Collapse
Affiliation(s)
- Linda C Lee
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Armando J Lorenzo
- The Hospital for Sick Children, Toronto, ON, Canada;; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Martin A Koyle
- The Hospital for Sick Children, Toronto, ON, Canada;; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
10
|
Thacker PG, Collins HR, Hill J. Distress experienced during pediatric VCUGs - a granular, prospective assessment using the brief behavioral distress scale. Pediatr Radiol 2016; 46:660-5. [PMID: 26860095 DOI: 10.1007/s00247-016-3540-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 11/18/2015] [Accepted: 01/06/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND In spite of decades of experience with the procedure, controversy persists as to the overall distress experienced by children and the routine need for sedation in children undergoing voiding cystourethrograms (VCUG). Many studies have attempted to address these issues, often divided into one camp that champions routine sedation while another group believes that pretest preparation is often all that is needed. At the root of these issues are some of the limitations of previous studies as most incorporate inherently subjective parental questionnaires to determine distress levels rather than using an objective, unbiased observer. OBJECTIVE The objective of this study is to use a validated and reliable tool (the brief behavioral distress scale) to objectively evaluate the distress experienced during VCUGs. MATERIALS AND METHODS A prospective study of 26 children (ages 3-7 years old) was performed by the pediatric radiology department at a large urban academic medical center. Patients were evaluated for distress during 12 separate VCUG steps beginning with the patient entering the room and ending with the clothing being replaced at study completion. RESULTS Using a general linear model (repeated measures analysis of variance (ANOVA)), significant distress was identified during two phases of the examination, catheter insertion (P-values ranging <0.001-0.19) and the full bladder phase (P-values ranging 0.005-0.043). The mean distress score for catheter insertion (mean: 1.38, standard deviation [SD]: 1.098) was nearly three times higher than the next most distressful step, i.e. full bladder (mean: 0.65, SD: 0.745). Additionally, entering the room was perceived as significantly more distressing than the catheter out (P = 0.016) and clothing replacement phase (P = 0.006). CONCLUSION We find that despite there being significantly increased distress during the catheter insertion and full bladder phases, the distress levels during VCUGs are markedly less than in previous reports. Even the most distressful stage, catheterization, was less stressful than previously reported with levels closer to that of minor distress evinced by comfort-seeking behavior from a parent rather than more significant distress resulting in screaming. Our findings corroborate and expand on the conclusion of the effectiveness of pretest preparation and child life specialist involvement.
Collapse
Affiliation(s)
- Paul G Thacker
- Department of Radiology and Radiological Science and Department of Pediatrics, Medical University of South Carolina, MSC 322, 96 Jonathan Lucas St., Charleston, SC, 29425, USA.
| | - Heather R Collins
- Department of Radiology and Radiological Science, Medical University of South Carolina, MSC 322, 96 Jonathan Lucas St., Charleston, SC, 29425, USA
| | - Jeannie Hill
- Department of Radiology and Radiological Science and Department of Pediatrics, Medical University of South Carolina, MSC 322, 96 Jonathan Lucas St., Charleston, SC, 29425, USA
| |
Collapse
|
11
|
Telli O, Mermerkaya M, Hajiyev P, Aydogdu O, Afandiyev F, Suer E, Soygur T, Burgu B. Is top-down vs bottom-up radiological evaluation after febrile urinary tract infection really less stressful for the child and family? Challenging the dogma. J Urol 2014; 193:958-62. [PMID: 25444953 DOI: 10.1016/j.juro.2014.10.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE We evaluated whether stress levels in children and parents during radiological evaluation after febrile urinary tract infection are really lower using the top-down approach, where (99m)technetium dimercaptosuccinic acid renal scintigraphy is used initially, than the bottom-up approach, where voiding cystourethrography is initially performed and repeated examinations are easier for all. MATERIALS AND METHODS We prospectively evaluated 120 children 3 to 8 years old. Pain ratings were obtained using the Faces Pain Scale-Revised, and conversation during the procedure was evaluated using the Child-Adult Medical Procedure Interaction Scale-Revised by 2 independent observers. To evaluate parental anxiety, the State-Trait Anxiety Inventory form was also completed. Following a documented febrile urinary tract infection children were randomized to the top-down or bottom-up group. A third group of 44 children undergoing repeat voiding cystourethrography and their parents were also evaluated. RESULTS Child ratings of pain using the Faces Pain Scale-Revised were not significantly different between the top-down group following (99m)technetium dimercaptosuccinic acid renal scintigraphy (2.99 on a scale of 10) and the bottom-up group following voiding cystourethrography (3.21). Also the Faces Pain Scale-Revised was not significantly different in the repeat voiding cystourethrography group (3.35). On the Child-Adult Medical Procedure Interaction Scale-Revised there was negative correlation between child coping and child distress, as well as rate of child distress and adult coping promoting behavior. Parental state anxiety scores were significantly less in the top-down and repeat voiding cystourethrography groups than in the bottom-up group. CONCLUSIONS Although the top-down approach and repeat voiding cystourethrography cause less anxiety for caregivers, these values do not correlate to pain scale in children. This finding might be due to lack of appropriate evaluation tools of pediatric pain and anxiety. However, the theory that the top-down approach is less invasive, and thus less stressful, requires further research. The Child-Adult Medical Procedure Interaction Scale-Revised data indicate that influences in adult-child interaction are bidirectional.
Collapse
Affiliation(s)
- Onur Telli
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey.
| | - Murat Mermerkaya
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Perviz Hajiyev
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Ozgu Aydogdu
- Urology Clinic, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Faraj Afandiyev
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Evren Suer
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Tarkan Soygur
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Berk Burgu
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey
| |
Collapse
|