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Urine Testing in Children with Viral Symptoms: A Nationwide Analysis of Ambulatory Visits, 2014-2019
Rachel L Wattier1, Daniel J Shapiro2, Hillary L Copp3
1Department of Pediatrics, University of California San Francisco, San Francisco, CA.
Insights
Urine testing for viral symptoms in children is common, particularly in emergency departments. This potentially avoidable testing disproportionately affects older children with a lower risk of urinary tract infections.
Area of Science:
- Pediatric Healthcare
- Diagnostic Testing
- Public Health
Background:
- Urine testing is frequently performed during pediatric ambulatory visits.
- Viral illnesses are a common reason for pediatric visits.
- The necessity of urine testing for non-genitourinary symptoms is often questionable.
Purpose of the Study:
- To determine the frequency of urine testing in US pediatric ambulatory visits for viral symptoms.
- To identify factors associated with urine testing in these visits.
Main Methods:
- Analysis of a nationally representative sample of pediatric ambulatory visits (2014-2019).
- Identification of visits for viral symptoms (respiratory, rash, diarrhea) without genitourinary complaints.
- Logistic regression used to evaluate factors associated with urine testing (urinalysis/urine culture).
Main Results:
- Annually, 61% of pediatric visits were for viral symptoms without genitourinary issues.
- Urine testing occurred in 38% of these visits.
- Emergency department visits had higher rates of urine testing (8.3%) compared to clinic visits (4.4%), with older females showing the highest probability.
Conclusions:
- Urine testing for children with viral symptoms is frequent in ambulatory settings.
- This testing is potentially avoidable and occurs more in older age groups at lower risk for urinary tract infections.
Objective:
To evaluate the extent of and factors associated with urine testing in US pediatric ambulatory visits for symptoms commonly associated with viral illness.
Study Design:
We analyzed a nationally representative, cross-sectional sample of ambulatory clinic and emergency department (ED) visits among children 2 months to 17 years old (2014 through 2019 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey). Using reason for visit classification codes, we identified visits for respiratory symptoms, diarrhea, or rash; termed "viral symptoms" without reported localizing genitourinary symptoms. We assessed the proportion of these visits with urine testing (urinalysis and/or urine culture) and evaluated factors associated with urine testing using logistic regression.
Results:
Of 71.3 million (95% CI 64.7-78.0 million) pediatric ambulatory visits per year, 61% (95% CI 59%-63%) were for viral symptoms without reported genitourinary symptoms. Urine testing at these visits accounted for 38% (95% CI 30%-47%) of overall urine testing. Such testing occurred more frequently at ED visits (8.3%; 95% CI 7.4%-9.3%) compared with clinic visits (4.4%; 95% CI 2.5%-7.7%). At ED visits, the adjusted probability of urine testing in the context of viral symptoms was lowest for males age 2 months to <2 years (5%; 95% CI 3%-6%) and highest for females age 12 through 17 years (20%; 95% CI 16%-24%), and females age 6-11 years (13%; 95% CI 11%-16%).
Conclusions:
Urine testing in children with symptoms of viral or other non-urinary tract infection illnesses occurs frequently at ambulatory visits. This potentially avoidable testing disproportionately occurred in older age groups that have lower risk of urinary tract infection.
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