Ultrasound Overused to Diagnose Undescended Testicle

Diana Phillips

August 12, 2015

Ultrasound is of limited value for the diagnosis, treatment planning, and prognostication of undescended testicle (UDT), and its overuse in children and youth contributes to treatment delays, according to the results of a new study.

"We found that it can delay access to timely corrective surgery and can mislead referring physicians and specialists alike," Niki Kanaroglou, MD, from the Division of Urology, The Hospital for Sick Children, and Department of Surgery, University of Toronto, Ontario, Canada, and colleagues report in an article published online August 10 in Pediatrics. "This weighty misallocation of resources could be channeled to children in need; it is also an area of potential cost savings at a time when health care budgets are under scrutiny."

The American Urological Association guidelines underscore the limited value of ultrasound imaging in UDT, explain the study investigators.

To look at the use of the imaging technology, the researchers reviewed records from a provincial population-based health administrative database of boys between 0 and 18 years of age diagnosed with UDT in Ontario between 2000 and 2011. They also reviewed institutional data for boys with UDT referred to The Hospital for Sick Children between 2007 and 2011.

The researchers examined the administrative data for trends in frequency, distribution, and costs of ultrasound and to compare time delays between diagnosis and definitive management between the ultrasound and nonultrasound groups. The institutional data were used to assess demographic patterns of ultrasound use and to compare the diagnostic accuracy of ultrasound, based on surgical findings.

Ultrasound correctly predicted physical examination findings in only 54% of patients, the authors report. Despite its limited value, the imaging technique was used in 33.5% of provincial referrals and 50% of institutional referrals, they write. In addition, they found that surgical treatment was delayed by approximately 3 months in children who underwent ultrasound.

The authors also report a 31.4% increase in the use of ultrasound by referring practitioners in the 7466 boys who underwent surgical exploration for UDT during the period of review (P = .0001). "This overuse represents a substantial added cost in an already strained single-payer, universal access system," the authors write, adding that the delay in timely corrective treatment may adversely affect outcomes.

"These findings have widespread implications for resource utilization and access to care, even outside of the Canadian context," the authors stress, calling for broader dissemination of updated practice guidelines and widespread educational efforts targeting, in particular, current and future referring physicians.

"A multifaceted approach will likely have the biggest impact," they add. "Potential ideas include dissemination of guidelines in the pediatric and radiologic literature, interdisciplinary e-rounds, mandatory continuing medical education credits, telemedicine journal clubs, online 'ask-the-expert' sessions, and targeted efforts in medical school," they write. "With the variety of communication and social media technologies available today, there is no better time to initiate a lasting change in practice."

This study was supported by the Institute for Clinical Evaluative Sciences, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online August 10, 2015. Abstract

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