Albert S Lee1, Laura McGarry1, Diana K Bowen2, Gregory E Tasian3. 1. Department of Urology, Einstein Healthcare Network, Philadelphia, PA. 2. Division of Urology, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL. 3. Department of Surgery, Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Surgery, Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: tasiang@chop.edu.
Abstract
OBJECTIVE: To inform the development of strategies to improve adherence to guidelines, we sought to identify characteristics of pediatric patients with nephrolithiasis associated with completing 24-hour urine analyses. MATERIALS AND METHODS: We performed a retrospective cohort study of patients with nephrolithiasis aged 3-18years treated in a large pediatric healthcare system from May 2012 to May 2017. Multivariable Cox models were fit to estimate the association between patient characteristics and completion of a 24-hour urine analysis. RESULTS: Among 623 patients, 317 (50.9%) completed a 24-hour urine collection. Median age was 14.4years (interquartile range [IQR] 10.5, 16.3). In adjusted analyses, age at diagnosis (hazard ratio [HR] 1.03; 95% confidence interval [CI] 1.01-1.07), renal colic on presentation (HR 1.72; 95% CI 1.15-2.58), and family history of nephrolithiasis (HR 1.50; 95% CI 1.17-1.93) were associated with an increased likelihood of completion of a 24-hour urine. Public/government assistance insurance (HR 0.68; 95% CI 0.48-0.96) was associated with decreased likelihood of completing a 24-hour urine. CONCLUSION: Patients who had prior painful experiences with stones (renal colic), and potential better understanding of nephrolithiasis (family history, older age on presentation) were more likely to complete a 24-hour urine. Those patients with public insurance/government assistance were less likely to complete a 24-hour urine. These results can be used to develop strategies to improve pediatric patients' adherence to completing 24-hour urine collections.
OBJECTIVE: To inform the development of strategies to improve adherence to guidelines, we sought to identify characteristics of pediatric patients with nephrolithiasis associated with completing 24-hour urine analyses. MATERIALS AND METHODS: We performed a retrospective cohort study of patients with nephrolithiasis aged 3-18years treated in a large pediatric healthcare system from May 2012 to May 2017. Multivariable Cox models were fit to estimate the association between patient characteristics and completion of a 24-hour urine analysis. RESULTS: Among 623 patients, 317 (50.9%) completed a 24-hour urine collection. Median age was 14.4years (interquartile range [IQR] 10.5, 16.3). In adjusted analyses, age at diagnosis (hazard ratio [HR] 1.03; 95% confidence interval [CI] 1.01-1.07), renal colic on presentation (HR 1.72; 95% CI 1.15-2.58), and family history of nephrolithiasis (HR 1.50; 95% CI 1.17-1.93) were associated with an increased likelihood of completion of a 24-hour urine. Public/government assistance insurance (HR 0.68; 95% CI 0.48-0.96) was associated with decreased likelihood of completing a 24-hour urine. CONCLUSION:Patients who had prior painful experiences with stones (renal colic), and potential better understanding of nephrolithiasis (family history, older age on presentation) were more likely to complete a 24-hour urine. Those patients with public insurance/government assistance were less likely to complete a 24-hour urine. These results can be used to develop strategies to improve pediatric patients' adherence to completing 24-hour urine collections.
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