Indications of imaging and challenges of adherence to imaging guidelines in children with urological conditions: A retrospective cross-sectional multi-centre study

Abstract

Introduction Urological conditions in children in Uganda are diverse and they include congenital anomalies, trauma, tumors and urinary tract infections. Amongst these conditions, congenital conditions are the commonest i.e. cryporchidims and hypospadius. These conditions often require imaging for accurate diagnosis, treatment planning, and follow-up. However, establishing appropriate imaging recommendations for children presents challenges due to the need to balance diagnostic accuracy while minimizing radiation exposure and also avoiding unnecessary costs of the imaging. From clinical observations it has been shown that many clinicians make inappropriate imaging recommendations for children with urological conditions due to a number of reasons. There is paucity of data in uganda regarding the use of imaging guidelines and the challenges that clinicians face while trying to adhere to these imaging guidelines. Objective To determine the indications for imaging and the challenges of adherence to imaging guidelines in children with urological conditions at MNRH and St.Francis Nsambya Hospital. Method A retrospective cross-sectional study was conducted at MNRH and St.Francis Nsambya hospital. A review of 424 imaging request forms of children with urological conditions was conducted and 60 clinicians were subjected to pre-structured self administered questionnaires. Results The study enrolled 424 patients. The most common indications for imaging was cryptorchidism 17.45%(74), inguinal scrotal hernia 15.57%(66), UTI 12.03%(51), acute scrotum(orchitis, torsion) 12.03%(51). The overall degree of adherence was moderate at 66.51% (CI 0.619-0.709). However in some specific conditions the degree of non-adherence was high i.e. cryptorchidism 98%(73), trauma 90.91%(10) and PUV 85.19%(23).The commonest challenges of adhering to imaging guidelines were cost related issues 70%(42), lack of access to appropriate imaging modalities 55%(33), limited awareness or familiarity with the guidelines 38.33%(23) and the absence of local guidelines 35%(21). Conclusion The overall adherence to imaging guideline in children with urological conditions is moderate 66.5%(282). However there is a significant gap in the degree of adherence to some specific conditions like cryptorchidism and trauma with non-adherence rates as high as 98%(73) and 90.9%(10) respectively. This could be as a result of lack of knowledge of the imaging guidelines. The most common challenges faced by clinicians while adhering to imaging guidelines include cost limitations, limited access to imaging resources, insufficient awareness of guidelines and lack of local guidelines