Presentation Authors: Aylin Bilgutay*, Michael Garcia-Roig, Courtney McCracken, Andrew Kirsch, Atlanta, GA
Introduction: Vesicoureteral reflux (VUR) is a common cause of febrile urinary tract infections (fUTI) in children. The 2011 AAP UTI guidelines recommended a VCUG after the second fUTI or if anomalies are seen on renal/bladder ultrasound following the initial fUTI. The VURx estimates the likelihood of spontaneous VUR resolution based on gender, VUR timing/grade, and anatomic abnormalities. Higher VURx correlates with lower likelihood of spontaneous resolution (Fig. 1a), and therefore more clinically significant VUR. We hypothesized the VURx score of new VUR diagnosis would increase after 2011, representing increased diagnosis of clinically significant VUR that is less likely to resolve spontaneously.
Methods: VUR patients diagnosed from 2006-2014 were identified. Demographics, date of diagnosis, and VURx were collected. VURx was compared in patients diagnosed before and after 10/1/2011 to assess guideline impact.
Results: We studied 661 children diagnosed between 1/2006 and 12/2014. There were 489 patients (mean 1.5 years old, 75% female) in the pre-guideline period, and 172 patients (mean 2.4 years old, 82% female) post-guideline. We found no significant difference in the mean, median, or distribution of VURx in children diagnosed before (3.25 Â± 0.96) or after (3.33 Â± 0.92) the 2011 guidelines (p=0.340). However, between 2006 and 2014, there was a gradual increase in the mean VURx scores of 0.04 points per year (95% CI 0.02-0.07, p=0.008). The slope was not significantly different before or after 10/1/2011 (p=0.35) (Fig. 1b).
Conclusions: There was no difference in mean VURx score before or after 2011 guideline publication. A gradual increase in mean VURx at our institution was seen between 2006 and 2014 that did not correlate with guideline publication. Therefore, practice patterns were already trending towards identifying more clinically significant VUR (i.e. patients with higher risk of non-resolution and those at risk for fUTIs) even before guideline publication.