title: Overuse of fluoroscopic gastrostomy studies in a children's hospital.
abstract: BACKGROUND
  Gastrostomy tubes are often dislodged or exchanged in children. Indications for fluoroscopic examination of gastrostomy location include concern for malposition, dislodgement, leak, or gastric outlet obstruction. We hypothesized that most of the studies obtained at our institution were not ordered for one of the aforementioned indications and do not ultimately affect patient management.
  
  
  METHODS
  All fluoroscopic gastrostomy studies performed from January 2011 to December 2012 were reviewed. Transgastric jejunostomy studies were excluded. Patient demographics, indications for the study, elapsed time since placement, imaging findings, and short-term outcomes were recorded. Chi-square analysis was used to evaluate relationships between categorical variables.
  
  
  RESULTS
  During the study period, 337 patients who underwent fluoroscopic gastrostomy studies were identified; median age was 2.5 y (0.05-23.8). Sixty-two percent (208/337) of the studies were ordered in asymptomatic patients to confirm tube placement location after routine exchange or replacement. Symptomatic patients accounted for 38% of the studies. Ordering physicians were primarily nonsurgeons (72%, 242/337). Abnormal findings were observed in 4.8% (16/337) of patients, six (1.7%) of whom required an operative intervention. The 2.9% (6/208) abnormal study rate for asymptomatic patients was significantly lower than the 7.9% (10/129) rate in the patients who were evaluated for symptomatic indications (P = 0.03).
  
  
  CONCLUSIONS
  Most of the fluoroscopic gastrostomy studies ordered at a tertiary care center did not appear to alter patient care. Development of a standardized management algorithm based on clinical indications is necessary to decrease the number of extraneous gastrostomy studies.
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Irving J
authors.initials: IJ
authors.lastname: Zamora
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Fallon
authors.affiliation: Edward B. Singleton Department of Pediatric Radiology, Baylor College of Medicine, Houston, Texas.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Orth
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Kim
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Brandt
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Monica E
authors.initials: ME
authors.lastname: Lopez
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: David E
authors.initials: DE
authors.lastname: Wesson
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas. Electronic address: rxrodri2@texaschildrens.org.
authors.forename: Jose Ruben
authors.initials: JR
authors.lastname: Rodriguez
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005471:Fluoroscopy / Q000706:statistics & numerical data; D005774:Gastrostomy / Q000009:adverse effects*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011860:Radiography, Abdominal / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Gastrostomy; Gastrostomy contrast study; Imaging overuse; Pediatrics; Quality improvement