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VARIATION IN THE REPORTING OF PEDIATRIC VOIDING
CYSTOURETHROGRAM FINDINGS
Anthony SCHAEFFER
1
, Saul GREENFIELD
2
, Anastasia IVANOVA
3
, Gang CUI
3
, Michael ZERIN
4
, Jeanne CHOW
5
, Alejandro
HOBERMAN
6
, Ron KEREN
7
, Ranjiv MATHEWS
8
, Tej MATTOO
9
, Myra CARPENTER
3
, Marva MOXEY-MIMS
10
, Russell
CHESNEY
11
and Caleb NELSON
1
1) Boston Children's Hospital, Urology, Boston, USA - 2) Women & Children's Hospital of Buffalo, Pediatric Urology,
Buffalo, USA - 3) University of North Carolina, Collaborative Studies Coordinating Center, Dept of Biostatistics, Chapel
Hill, USA - 4) Children's Hospital of Michigan, Radiology, Detroit, USA - 5) Boston Children's Hospital, Radiology, Boston,
USA - 6) University of Pittsburgh, Pediatrics, Pittsburgh, USA - 7) Children's Hospital of Philadelphia, Pediatrics,
Philadelphia, USA - 8) Johns Hopkins Hospital, Urology, Baltimore, USA - 9) Children's Hospital of Michigan, Pediatrics,
Detroit, USA - 10) National Institutes of Health, National Institute of Diabetes and Digestive Kidney Disease, Bethesda,
USA - 11) University of Tennessee Health Sciences Centher, Pediatrics, Memphis, USA
PURPOSE
VCUG provides a wealth of data on urinary tract function and anatomy, but few standards exist for reporting VCUG
findings. We sought to assess VCUG report quality from a wide range of institutions, using a standardized assessment
tool.
MATERIAL AND METHODS
Among the 607 children enrolled in the RIVUR trial, we analyzed the 602 available original VCUG reports. A 23-item
checklist was used to evaluate reporting of technical, anatomic, and functional information (e.g. reflux grade, bladder
capacity, assessment of skeletal anatomy, filling vs. voiding onset of VUR, etc). Patient, radiologist, and institutional
information were collected. Facilities were categorized as free-standing pediatric hospitals (FSPH), pediatric “hospitals
within a hospital” (PHWH), non-pediatric hospitals (NPH), or outpatient radiology facilities (ORF). Multivariate linear
regression was used to analyze factors associated with the completeness of VCUG reports (% of items reported).
RESULTS
602 VCUG’s were performed at 91 different institutions. 76% were read by a pediatric radiologist. 50% were performed
at a FSPH, 30% at PHWH, 15% at NPH, and 5% at ORF. On average, less than half of items were included in VCUG
reports (mean % of items: 48±12%). Report completeness varied by facility type: 51±11% at FSPH, 50±10% at PHWH,
36±11% at NPH, and 43±8% at ORF (p<0.0001). Clinically-significant items reported infrequently included bladder
volume at reflux onset (2%), collecting system duplication (6%), ureteral insertion site (11%), and delayed images for
assessment of obstruction (25%). In multivariate analysis, VCUG reports generated at NPH or ORF had 8% fewer items
included (95% CI: 3-13%, p<0.01), and those generated at PHWH were no different, compared to FSPH. Reports read
by a non-pediatric radiologist had 6% fewer items included (3-10%, p<0.01), compared to those read by a pediatric
radiologist.
CONCLUSIONS
There is significant variability among facilities and radiologists in the completeness of VCUG reporting, with more
complete reports from FSPH and pediatric radiologists.