title: Inappropriate Use of Ultrasound in Management of Pediatric Cryptorchidism.
abstract: OBJECTIVE
  There is a limited role for ultrasound in the management of an undescended testicle (UDT). We hypothesized that ultrasound remains overused by referring physicians. Our goal was to characterize the trends, patterns, and impact of ultrasound use for UDT and to reaffirm its limited diagnostic value for this indication.
  
  
  METHODS
  The records of boys aged 0 to 18 years with UDT in Ontario, Canada, between 2000 and 2011 were reviewed by using health administrative data housed at the Institute for Clinical and Evaluative Sciences (ICES). A second review of boys referred to our institution with UDT between 2007 and 2011 was conducted to complement the health administrative data. Trends in frequency, distribution, and costs of ultrasound use were assessed. Time delays between diagnosis and definitive management were compared between the ultrasound and non-ultrasound groups. Using our institutional data, we analyzed demographic patterns of ultrasound use and compared its diagnostic accuracy by using surgical findings as the gold standard.
  
  
  RESULTS
  Ultrasound was used in 33.5% of provincial referrals and 50% of institutional referrals. Children who underwent ultrasound experienced an approximate 3-month delay in definitive surgical management. Ultrasound correctly predicted physical examination findings in only 54% of patients. Physicians in community practice, and those with fewer years in practice, were more likely to order ultrasound.
  
  
  CONCLUSIONS
  Ultrasound has limited value for the management of UDT but remains widely overused, with an increasing trend over time. This practice has negative implications for access to care and cost-containment. Widespread educational efforts should be undertaken, targeting current and future referring physicians.
authors.affiliation: Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada;
authors.forename: Niki
authors.initials: N
authors.lastname: Kanaroglou
authors.affiliation: Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada;
authors.forename: Teresa
authors.initials: T
authors.lastname: To
authors.affiliation: Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada;
authors.forename: Jingqin
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Division of Urology, McMaster Children's Hospital and Department of Surgery, McMaster University, Hamilton, Ontario, Canada;
authors.forename: Luis H P
authors.initials: LH
authors.lastname: Braga
authors.affiliation: Division of Urology, University of California Irvine, Orange, California; and.
authors.forename: Elias
authors.initials: E
authors.lastname: Wehbi
authors.affiliation: Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada;
authors.forename: Mohammed
authors.initials: M
authors.lastname: Hajiha
authors.affiliation: Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada;
authors.forename: Darius J
authors.initials: DJ
authors.lastname: Bägli
authors.affiliation: Division of Urology, Department of Surgery, Sidra Medical and Research Center, Doha, Qatar.
authors.forename: Joao Pippi
authors.initials: JP
authors.lastname: Salle
authors.affiliation: Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada;
authors.forename: Martin A
authors.initials: MA
authors.lastname: Koyle
authors.affiliation: Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; armando.lorenzo@sickkids.ca.
authors.forename: Armando J
authors.initials: AJ
authors.lastname: Lorenzo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003456:Cryptorchidism / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D009864:Ontario; D011379:Prognosis; D012017:Referral and Consultation; D013997:Time Factors; D014463:Ultrasonography / Q000191:economics / Q000706:statistics & numerical data; D019564:Unnecessary Procedures