VARIABILITY IN MANAGEMENT OF SYMPTOMLESS MICROHEMATURIA IN SCHOOLCHILDREN

The evaluation of incidentally detected symptomless microhaematuria in school-children is controversial. Some authors advocate varying numbe rs of immediate tests, while others recommend investigations only in c ases who develop systemic symptoms or signs, or a decline in renal fun ction. 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 a sked 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%), respect ively. The mean number of requested tests, other than follow-up examin ation 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 neph rologists, at an average cost of NIS 408 (US$ 136), NIS 454 (US$ 151) and NIS 860 (US$ 286), respectively. There was also a marked variabili ty within subspecialty groups, so that some family physicians recommen ded more tests at a higher cost than some of the paediatric nephrologi sts. There was a marked and unexplained variability within and among t he three groups of respondents regarding the extent of the evaluation. The main reason for this variability is probably the uncertainty abou t the scientifically appropriate way to approach this condition in a s ymptomless child.