Accepted Manuscript Evaluating Hematuria: Impact of Guideline Adherence on Urologic Cancer Diagnosis Atul B. Shinagare, MD Stuart G. Silverman, MD Esteban F. Gershanik, MD, MPH Steven L. Chang, MD, MS Ramin Khorasani, MD, MPH PII:
S0002-9343(14)00145-4
DOI:
10.1016/j.amjmed.2014.02.013
Reference:
AJM 12404
To appear in:
The American Journal of Medicine
Received Date: 27 November 2013 Revised Date:
3 February 2014
Accepted Date: 4 February 2014
Please cite this article as: Shinagare AB, Silverman SG, Gershanik EF, Chang SL, Khorasani R, Evaluating Hematuria: Impact of Guideline Adherence on Urologic Cancer Diagnosis, The American Journal of Medicine (2014), doi: 10.1016/j.amjmed.2014.02.013. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Title: Evaluating Hematuria: Impact of Guideline Adherence on Urologic Cancer Diagnosis Running Head: Guideline adherence in evaluation of hematuria Type of Manuscript: Clinical Research Study
Authors: 1Atul B. Shinagare, MD, 1Stuart G. Silverman, MD,
1,3
MPH, 4Steven L. Chang, MD, MS, 1Ramin Khorasani, MD, MPH.
RI PT
Key words: Hematuria; diagnostic evaluation; adherence to guidelines; variability in practice Esteban F. Gershanik, MD,
SC
Affiliation: 1Department of Radiology and Center for Evidence-Based Imaging, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75
M AN U
2
Francis St, Boston, MA 02115 3
Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis
St, Boston, MA 02115
Department of Urologic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75
Francis St, Boston, MA 02115
TE D
4
Corresponding Author: Atul B. Shinagare, M.D.
EP
Address: Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115. Email: [email protected]
AC C
Previously published: None Funding Sources: None
Conflicts of interest: None (all authors) All the authors had access to the data and played a role in writing and editing the manuscript.
ACCEPTED MANUSCRIPT
RI PT
Evaluating Hematuria: Impact of Guideline Adherence on Urologic Cancer Diagnosis
AC C
EP
TE D
M AN U
SC
Type of Manuscript: Clinical Research Study
Abstract
ACCEPTED MANUSCRIPT
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.
RI PT
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 longterm follow-up), we randomly selected 100 of 1771 patients with asymptomatic hematuria (52
SC
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
M AN U
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
TE D
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
S0002-9343(14)00145-4
DOI:
10.1016/j.amjmed.2014.02.013
Reference:
AJM 12404
To appear in:
The American Journal of Medicine
Received Date: 27 November 2013 Revised Date:
3 February 2014
Accepted Date: 4 February 2014
Please cite this article as: Shinagare AB, Silverman SG, Gershanik EF, Chang SL, Khorasani R, Evaluating Hematuria: Impact of Guideline Adherence on Urologic Cancer Diagnosis, The American Journal of Medicine (2014), doi: 10.1016/j.amjmed.2014.02.013. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Title: Evaluating Hematuria: Impact of Guideline Adherence on Urologic Cancer Diagnosis Running Head: Guideline adherence in evaluation of hematuria Type of Manuscript: Clinical Research Study
Authors: 1Atul B. Shinagare, MD, 1Stuart G. Silverman, MD,
1,3
MPH, 4Steven L. Chang, MD, MS, 1Ramin Khorasani, MD, MPH.
RI PT
Key words: Hematuria; diagnostic evaluation; adherence to guidelines; variability in practice Esteban F. Gershanik, MD,
SC
Affiliation: 1Department of Radiology and Center for Evidence-Based Imaging, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75
M AN U
2
Francis St, Boston, MA 02115 3
Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis
St, Boston, MA 02115
Department of Urologic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75
Francis St, Boston, MA 02115
TE D
4
Corresponding Author: Atul B. Shinagare, M.D.
EP
Address: Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115. Email: [email protected]
AC C
Previously published: None Funding Sources: None
Conflicts of interest: None (all authors) All the authors had access to the data and played a role in writing and editing the manuscript.
ACCEPTED MANUSCRIPT
RI PT
Evaluating Hematuria: Impact of Guideline Adherence on Urologic Cancer Diagnosis
AC C
EP
TE D
M AN U
SC
Type of Manuscript: Clinical Research Study
Abstract
ACCEPTED MANUSCRIPT
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.
RI PT
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 longterm follow-up), we randomly selected 100 of 1771 patients with asymptomatic hematuria (52
SC
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
M AN U
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
TE D
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
