title: Variation in the level of detail in pediatric voiding cystourethrogram reports.
abstract: BACKGROUND
  Voiding cystourethrogram (VCUG) provides a wealth of data on urinary tract function and anatomy, but few standards exist for reporting VCUG findings.
  
  
  OBJECTIVE
  We aimed to assess variability in VCUG reports and to test our hypothesis that VCUG reports from pediatric facilities and pediatric radiologists are more complete than those performed at other facilities or by non-pediatric radiologists.
  
  
  METHODS
  We analyzed original VCUG reports from children enrolled in the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial. A 23-item checklist was created and used to evaluate reporting of technical (e.g. catheter size), anatomic (e.g. vesicoureteral reflux (VUR) presence and grade, bladder shape), and functional information (e.g. bladder emptying). Radiologists were classified as pediatric or non-pediatric radiologists. Facilities were categorized as to whether they were a free-standing pediatric hospital (FSPH), a pediatric "hospital within a hospital" (PHWH), a non-pediatric hospital (NPH), or an outpatient radiology facility (ORF). Multivariate linear regression was used to analyze factors associated with the completeness of the VCUG reports (percent of items reported from the 23-item checklist).
  
  
  RESULTS
  Six-hundred and two VCUGs were performed at 90 institutions. Of those, 76% were read by a pediatric radiologist, and 49% were performed at a FSPH (Table). On average, less than half of the 23 items in our standardized assessment tool were included in VCUG reports (mean 48%, SD 12). The completeness of reports varied by facility type: 51% complete at FSPH (SD 11), 50% at PHWH (SD 10), 36% at NPH (SD 11), and 43% at ORF (SD 8) (p < 0.0001). In multivariate analysis, VCUG reports generated at NPH or ORF had 8% fewer items included (95% CI 3.0-12.8, p < 0.01), and those generated at PHWH did not differ from those generated at FSPH. Reports read by a non-pediatric radiologist had 6% fewer items included (95% CI 3-9.7; p < 0.01) compared with those read by a pediatric radiologist.
  
  
  CONCLUSIONS
  There is substantial underreporting of findings in VCUG reports when assessing a widely represented sample of routine, community-generated reports using an idealized standard. Although VUR was often reported, other crucial anatomic and functional findings of the VCUG were consistently underreported across all facility types.
  
  
  CONCLUSIONS
  Although pediatric radiologist and pediatric hospitals generated more complete VCUG reports compared with those having non-pediatric origins, the differences are small when considering the substantial underreporting of VCUG findings in general. This underscores the opportunities for improvement in reporting of VCUG findings.
authors.affiliation: Department of Surgery, Division of Pediatric Urology, University of Utah School of Medicine, Salt Lake City, UT, USA. Electronic address: aschaeffer78@gmail.com.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Schaeffer
authors.affiliation: Department of Urology, Boston Children's Hospital, Boston, MA, USA; Department of Radiology, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Chow
authors.affiliation: Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Ivanova
authors.affiliation: Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Gang
authors.initials: G
authors.lastname: Cui
authors.affiliation: Department of Pediatric Urology, Women & Children's Hospital of Buffalo, Buffalo, NY, USA.
authors.forename: Saul P
authors.initials: SP
authors.lastname: Greenfield
authors.affiliation: Department of Radiology, Children's Hospital of Michigan, Detroit, MI, USA.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Zerin
authors.affiliation: Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Hoberman
authors.affiliation: Department of Urology, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Ranjiv I
authors.initials: RI
authors.lastname: Mathews
authors.affiliation: Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA.
authors.forename: Tej K
authors.initials: TK
authors.lastname: Mattoo
authors.affiliation: Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Myra A
authors.initials: MA
authors.lastname: Carpenter
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Marva
authors.initials: M
authors.lastname: Moxey-Mims
authors.affiliation: Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Russell W
authors.initials: RW
authors.lastname: Chesney
authors.affiliation: Department of Urology, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Caleb P
authors.initials: CP
authors.lastname: Nelson
mesh_terms: D000554:Ambulatory Care Facilities; D002675:Child, Preschool; D000070621:Cystography; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D011871:Radiology; D013038:Specialization; D014567:Urography; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging*
keywords: Fluoroscopy; Quality improvement; Radiology; Variation; Vesicoureteral reflux; Voiding cystourethrogram