Excretory urography in current practice: evidence against overutilization.
Excretory urography could be performed less frequently if some combinations of genitourinary signs and symptoms were found to be predictive of either a specific disease or normality. To explore this possibility, the authors conducted a prospective study involving more than 3,000 patients at three institutions (a teaching hospital, a community hospital, and a health maintenance organization). Predictive algorithms were obtained by application of a polychotomous logistic regression model but did poorly at differentiating normal from abnormal patients or arriving at a specific diagnosis. Selection of patients on the basis of the logistic model would have required testing 90% of all patients in order to detect 95% of those with abnormal urograms. These results suggest that current clinical selection criteria for excretory urography are effective, and that present frequency of utilization is appropriate.
D003937:Diagnosis, Differential; D005069:Evaluation Studies as Topic; D006279:Health Maintenance Organizations; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D008404:Massachusetts; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D014567:Urography / Q000706:statistics & numerical data*