J. A. Whitley1,2, S. Gnaneswaran2,3, M. Thach2,3, K. Kieran2 1Rice University,Houston, TX, USA 2Seattle Children’s Hospital,Seattle, WA, USA 3University Of Washington,Seattle, WA, USA
Introduction: Many families wish to have radiologic tests performed locally, especially when obtaining these tests in specialized pediatric centers would require long-distance travel and its associated costs and inconveniences. The differential availability of specialized and common pediatric uroradiographic tests in rural and urban areas has not been described. We undertook this study to describe the availability of common radiographic tests ordered by pediatric urologists, and to identify disparities in the availability of radiographic tests between urban and rural locations.
Methods: We surveyed all freestanding hospitals in Washington State (excluding single-specialty hospitals and those serving only adult patients) on the availability of flat plate abdominal X-rays (AXR), renal-bladder ultrasounds (RBUS), voiding cystourethrograms (VCUG), MAG-3 renal scans, and nuclear cystograms (NC) for children. Age restrictions, and availability of sedation for urology tests, of general and pediatric radiologists, and of services for patients with limited English proficiency (LEP) were recorded. Rural and urban hospitals were compared on these characteristics.
Results: 74/88 institutions (84.1%) completed the survey; 17 (23.0%) were rural (population <2500), 32 (43.2%) were in urban clusters (population 2500-50,000), and 25 (33.8%) were in urban areas (population >50,000). 73 (98.6%) institutions offered AXR, 68 (91.9%) offered RBUS, 44 (59.5%) offered VCUG, 26 (35.1%) offered MAG-3, and 15 (20.3%) offered NC to children. All urban and most (16/17; 94.1%) rural institutions had digital imaging capability. AXR (100% vs 96%, p=0.88) and RBUS (70.6% vs 96%, p=0.15) availability was similar in rural and urban settings, while VCUG (11.8% vs 72%, p=0.001), MAG-3 (5.9% vs 60%, p=0.006), and NC (0% vs 44%, p=0.017) were more commonly available in urban settings. Rural hospitals were less likely to employ full-time, in-house radiologists (35.3% vs 96%, p<0.0001) or offer sedation (6.3% vs 36%, p=0.01) for testing, but were equally likely to have age restrictions on the tests offered (17.6% vs 40%, p=0.50). Fellowship-trained pediatric radiologists (16% vs 0%, p=0.39) and child life specialists (20% vs 0%, p=0.28) worked exclusively in urban settings. 73 hospitals (98.6%) had interpreter services available, but translated written material was available in only 3 hospitals (4.1%).
Conclusion: The geographically widespread availability of AXR and RBUS may represent an opportunity to offer families care closer to home, saving money and time. Anxious children and those requiring more specialized studies may benefit from radiologic testing in urban centers. The limited written educational materials available for LEP patients is an opportunity for improvement. The availability of shareable digital imaging may foster collaboration between rural centers and urban-based pediatric radiologists. Further research is needed to understand what, if any, quality differences exist in radiographic studies obtained outside of urban and specialized pediatric centers.