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Evaluating Hematuria: Impact of Guideline Adherence on Urologic Cancer Diagnosis.
MedLine Citation:
PMID:  24565590     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: Assess physician adherence to 2001 American Urological Association (AUA) guidelines for evaluating patients with asymptomatic hematuria and its impact on the diagnosis of urologic cancer.
METHODS: In this institutional review board-approved retrospective study of patients with asymptomatic hematuria evaluated in a large academic health center in 2004 (allowing for long-term follow-up), we randomly selected 100 of 1771 patients with asymptomatic hematuria (52 men; mean age 54 years; 58 microscopic, 39 macroscopic, three unknown-type hematuria; median follow-up 89 months, interquartile range 33-97 months). Multivariate logistic regression assessed effects of age, gender, hematuria type, and physician specialty on guideline adherence, the primary outcome. Secondary outcome measures were variability in evaluation among physician specialists, and the proportion of patients developing urologic cancer.
RESULTS: Only 36 of 100 patients had a guideline-adherent evaluation, of whom five were diagnosed with urologic cancer (median 1 month, range 0-11). No urologic cancers were diagnosed in 64 patients with non-adherent evaluations. Only evaluation by a urologist significantly predicted guideline adherence (p<0.0001). Patients with gross hematuria more often underwent intravenous or CT urography (p=0.009); urologist evaluation more often led to intravenous or CT urography (p<0.0001), cystoscopy (p<0.0001), cytology (p=0.009) and guideline-adherent evaluation (p<0.0001).
CONCLUSIONS: Although most physicians did not adhere to 2001 AUA guidelines when evaluating patients with asymptomatic hematuria, no urologic cancers were diagnosed in patients without guideline-adherent evaluation, barring the possibility of occult cancers. Evaluation by a urologist was the only predictor of a guideline-adherent evaluation. Future studies are needed to determine the optimal evaluation of patients with asymptomatic hematuria.
Authors:
Atul B Shinagare; Stuart G Silverman; Esteban F Gershanik; Steven L Chang; Ramin Khorasani
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-2-21
Journal Detail:
Title:  The American journal of medicine     Volume:  -     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2014 Feb 
Date Detail:
Created Date:  2014-2-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 Elsevier Inc. All rights reserved.
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