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. 1998 Mar;74(869):161–164. doi: 10.1136/pgmj.74.869.161

Variability in management of symptomless microhaematuria in schoolchildren.

J Benbassat 1, M Gergawi 1, M Offringa 1, J E Bearman 1, A Drukker 1
PMCID: PMC2360829  PMID: 9640442

Abstract

The evaluation of incidentally detected symptomless microhaematuria in schoolchildren is controversial. Some authors advocate varying numbers of immediate tests, while others recommend investigations only in cases who develop systemic symptoms or signs, or a decline in renal function. The objective of this study was to estimate the extent to which this uncertainty affects the declared habits of practising physicians. A sample of 16 family physicians, 42 primary care paediatricians and 26 full-time hospital-based paediatric nephrologists in Israel were asked to complete a survey using a written case of a hypothetical eight-year-old boy with incidentally detected symptomless microhaematuria. Responses were received from 16 (100%), 18 (43%) and 18 (69%), respectively. The mean number of requested tests, other than follow-up examination of the urine, were 1.5 (range 0-5) for family physicians, 2.5 (1-5) for primary care paediatricians and 5.3 (2-12) for paediatric nephrologists, at an average cost of NIS 408 (US$ 136), NIS 454 (US$ 151) and NIS 860 (US$ 286), respectively. There was also a marked variability within subspecialty groups, so that some family physicians recommended more tests at a higher cost than some of the paediatric nephrologists. There was a marked and unexplained variability within and among the three groups of respondents regarding the extent of the evaluation. The main reason for this variability is probably the uncertainty about the scientifically appropriate way to approach this condition in a symptomless child.

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Selected References

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  1. Barneveld Binkhuysen F. H., Puylaert C. B. Influence of CT on radiologic utilization in The Netherlands. Radiology. 1988 Dec;169(3):827–829. doi: 10.1148/radiology.169.3.3187006. [DOI] [PubMed] [Google Scholar]
  2. Benbassat J., Gergawi M., Offringa M., Drukker A. Symptomless microhaematuria in schoolchildren: causes for variable management strategies. QJM. 1996 Nov;89(11):845–854. doi: 10.1093/qjmed/89.11.845. [DOI] [PubMed] [Google Scholar]
  3. Dodge W. F., West E. F., Smith E. H., Bruce Harvey 3rd Proteinuria and hematuria in schoolchildren: epidemiology and early natural history. J Pediatr. 1976 Feb;88(2):327–347. doi: 10.1016/s0022-3476(76)81012-8. [DOI] [PubMed] [Google Scholar]
  4. Donabedian A. Institutional and professional responsibilities in quality assurance. Qual Assur Health Care. 1989;1(1):3–11. doi: 10.1093/intqhc/1.1.3. [DOI] [PubMed] [Google Scholar]
  5. Fitzwater D. S., Wyatt R. J. Hematuria. Pediatr Rev. 1994 Mar;15(3):102–109. doi: 10.1542/pir.15-3-102. [DOI] [PubMed] [Google Scholar]
  6. Foreman J. W., Chan J. C. 10-year survey of referrals to a pediatric nephrology program. Child Nephrol Urol. 1990;10(1):8–13. [PubMed] [Google Scholar]
  7. Hisano S., Kwano M., Hatae K., Kaku Y., Yamane I., Ueda K., Uragoh K., Honda S. Asymptomatic isolated microhaematuria: natural history of 136 children. Pediatr Nephrol. 1991 Sep;5(5):578–581. doi: 10.1007/BF00856642. [DOI] [PubMed] [Google Scholar]
  8. Khatri K., Kaufman R., Baigelman W. Utilization of pulmonary function tests by primary care internists in a community hospital. Am J Med Qual. 1994 Summer;9(2):49–53. doi: 10.1177/0885713X9400900203. [DOI] [PubMed] [Google Scholar]
  9. Kingston M. E. Management of anemia in a general city hospital: value of chart review in establishing deficiencies in care. Can Med Assoc J. 1978 Jan 7;118(1):50–52. [PMC free article] [PubMed] [Google Scholar]
  10. Kitagawa T. Lessons learned from the Japanese nephritis screening study. Pediatr Nephrol. 1988 Apr;2(2):256–263. doi: 10.1007/BF00862602. [DOI] [PubMed] [Google Scholar]
  11. Laffel G., Blumenthal D. The case for using industrial quality management science in health care organizations. JAMA. 1989 Nov 24;262(20):2869–2873. [PubMed] [Google Scholar]
  12. Lieu T. A., Grasmeder H. M., 3rd, Kaplan B. S. An approach to the evaluation and treatment of microscopic hematuria. Pediatr Clin North Am. 1991 Jun;38(3):579–592. doi: 10.1016/s0031-3955(16)38119-6. [DOI] [PubMed] [Google Scholar]
  13. Vehaskari V. M., Rapola J., Koskimies O., Savilahti E., Vilska J., Hallman N. Microscopic hematuria in school children: epidemiology and clinicopathologic evaluation. J Pediatr. 1979 Nov;95(5 Pt 1):676–684. doi: 10.1016/s0022-3476(79)80710-6. [DOI] [PubMed] [Google Scholar]
  14. Vehaskari V. M. What is the prevalence of asymptomatic microscopic haematuria and how should such children be managed? Pediatr Nephrol. 1989 Jan;3(1):32–32. doi: 10.1007/BF00859621. [DOI] [PubMed] [Google Scholar]
  15. Wennberg J. E. Unwanted variations in the rules of practice. JAMA. 1991 Mar 13;265(10):1306–1307. [PubMed] [Google Scholar]

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