Newsroom | New study finds variation in urological test reporting among medical institutions

Boston, Mass., (June 3, 2014) – A recent study from Boston Children’s Hospital’s Departments of Urology and Radiology shows free-standing, pediatric hospitals have higher quality reporting of an invasive pediatric imaging test called Voiding Cystourethrogram (VCUG), compared to non-pediatric institutions.

The VCUG test, commonly used to identify urological conditions, requires a catheter to be placed into a child’s urethra, allowing the bladder to be filled with radiographic dye.  The contrast defines the shape of the bladder and urethra and identifies whether urine flows properly from the kidneys to bladder. 

The study, authored by Boston Children’s Urologist Anthony Schaeffer, MD, and published online in the journal Pediatric Radiology, compared VCUG reports from 38 medical institutions including 456 total subjects at:

• 3 free-standing pediatric hospitals (306 patients);
• 11 pediatric “hospitals within a hospital” (51 patients); and
• 24 non-pediatric facilities (99 patients)

The results found greater VCUG reporting accuracy with free-standing hospitals. Based on these finding, greater reporting accuracy could reduce repeat testing and patient radiation exposure.

“We have shown that VCUG reports, when performed at free-standing pediatric hospitals, consistently contain more useful and pertinent information for doctors which showcases the importance of pediatric expertise. This helps us more accurately counsel parents about their child’s condition,” said Dr. Schaeffer.

The study also states that unlike CT scans and MRI studies where all of the imaging data is recorded (and all images can be reexamined or reinterpreted), radiology departments only store a few representative VCUG images at study completion.  The report is, therefore, the only opportunity for complete documentation of the observed findings, other than the selected saved images themselves.

“Strategies to improve the completeness of VCUG reports would help the radiographic assessment, improve the quality of the report and reduce the harm from diagnostic radiation in these children,” the study states.

The study found non-pediatric hospitals had 17 percent fewer reported test findings and pediatric “hospitals within a hospital” had 9 percent fewer reported test findings compared to free-standing, pediatric hospitals.  Put another way, free-standing, pediatric hospitals consistently reported more complete VCUG test findings than other types of hospitals. 

Reports read by pediatric radiologists had 12 percent more reported test findings compared to those read by a non-pediatric radiologist.

Study senior author Caleb P. Nelson, MD, MPH, suggests instituting a comprehensive and standardized VCUG reporting tool  to reduce variation among medical institutions.

“To really improve patient care, we think that standardized reporting could significantly improve VCUG report quality, no matter where the test is performed.  Until this happens, our study shows that reports are much better when done at an institution with dedicated pediatric radiologist who are familiar with VCUGs,” Dr. Nelson said.

About Boston Children's Hospital Boston Children’s Hospital is home to the world’s largest research enterprise based at a pediatric medical center, where its discoveries have benefited both children and adults since 1869. More than 1,100 scientists, including seven members of the National Academy of Sciences, 13 members of the Institute of Medicine and 14 members of the Howard Hughes Medical Institute comprise Boston Children’s research community. Founded as a 20-bed hospital for children, Boston Children’s today is a 395-bed comprehensive center for pediatric and adolescent health care grounded in the values of excellence in patient care and sensitivity to the complex needs and diversity of children and families. Boston Children’s is also the primary pediatric teaching affiliate of Harvard Medical School. For more information about research and clinical innovation at Boston Children’s, visit: http://vectorblog.org.