Wide variation in VCUG reporting ‘embarrassing’

The significant variation in reporting of voiding cystourethrogram (VCUG) between free-standing pediatric and non-pediatric institutions unveiled in a recent study is “embarrassing,” according to one leading pediatric urologist.

The study, authored by researchers from Boston Children's Hospital and published online in the journal Pediatric Radiology (May 25, 2014), compared VCUG reports from 38 medical institutions including 456 total subjects at: three free-standing pediatric hospitals (306 patients), 11 pediatric "hospitals within a hospital" (51 patients), and 24 non-pediatric facilities (99 patients).

Non-pediatric hospitals had 17% fewer reported test findings, and pediatric "hospitals within a hospital" had 9% fewer reported test findings compared to free-standing pediatric hospitals, the authors found. Reports read by pediatric radiologists had 12% more reported test findings than those read by a non-pediatric radiologist.

Senior author Caleb P. Nelson, MD, MPH, suggests instituting a comprehensive, 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 radiologists who are familiar with VCUGs," Dr. Nelson said.

Howard M. Snyder III, MD, of the Children’s Hospital of Philadelphia, said he was not surprised by the findings.

“The huge variation in VCUGs is embarrassing to me,” said Dr. Snyder, a member of the Urology Times Editorial Council who was not involved in the study.

If not properly executed, Dr. Snyder said, a VCUG is “for all intents and purposes, worthless.” Overfilling the bladder during the test can precipitate vesicoureteral reflux when it wouldn’t normally occur physiologically, and failing to obtain voiding phases will miss 20% of reflux, he noted.

“I think Caleb Nelson is perfectly correct in that the standardization of the VCUG would be very worthwhile, not only for minimizing cost and radiation exposure to the patient but also [for improving] the quality of the study,” Dr. Snyder said.

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