Underuse of 24-hour urine collection among children with incident urinary stones: a quality-of-care concern?

Abstract

Objective: To determine the prevalence of 24-hour urine collection among first-time pediatric stone formers and investigate factors associated with its use.

Materials and methods: Using data from the MarketScan Commercial Claims and Encounters Database (2002-2006), children presenting to the emergency department with an incident episode of upper urinary tract stone disease were identified through a diagnosis code-based algorithm. The number of patients performing a 24-hour urine collection within 6 months of this encounter was calculated. Temporal trends in the prevalence of use were assessed. We fitted multivariate logistic regression models to examine factors associated with testing.

Results: In total, 1848 children presented with an incident upper tract stone, of which 12.0% submitted a 24-hour urine collection. This percentage remained stable over the study period. Testing was more common among younger patients (P <.001) and those who visited urologists (P <.001) or nephrologists (P <.001). The odds of testing were nearly 4-fold or 7-fold higher if the patient saw a urologist (odds ratio, 3.99; 95% confidence interval, 2.83-5.62) or a nephrologist (odds ratio, 7.00; 95% confidence interval, 3.95-12.41), respectively.

Conclusion: Despite rates of stone recurrence, 24-hour urine collection appears to be underused among children. Efforts to increase its use are therefore likely to benefit pediatric patients with urinary stone disease.