Expert Consensus on Standardized Reporting for Pediatric Urodynamics

Research study background

Urodynamic testing is a valuable tool for the diagnosis and management of lower urinary tract dysfunction and is commonly used in patients with neurogenic bladder. Variable reporting of pediatric urodynamic studies causes confusion among urologists, hindering interpretation, results comparison and research efforts. Pediatric urology societies have promoted standardized urodynamic nomenclature, yet pediatric urologists do not have formal guidelines that specify what should be included in their reports.

Kyle Rove, MD, lead study author and a pediatric urologist at Children’s Hospital Colorado, collaborated with other pediatric urology specialists to develop an expert consensus statement for creating a standardized pediatrics urodynamics report. Thirty pediatric urologists recognized as authorities in their field from 27 U.S. institutions across 21 states participated, each completing a three-round survey between November 2022 and August 2023. Members of the Epic Pediatric Urology Specialty Steering Board, of which Dr. Rove is a member, were also invited to weigh in on the feasibility of integrating a pediatric urodynamics report into Epic.

They sought to integrate clinical decision support within the electronic health record to yield multiple benefits to improve clinical utility, billing efficiency and research collaboration. Using a modified electronic Delphi technique, the survey gathered feedback on how the report should be organized, what sections and elements within each section should be included, what discrete options should be available for documentation and when clinical decision support should be used.

In each of the three rounds, more than an 80% consensus was reached for various components to be included in the report. The finalized consensus report details a standardized document with eight sections and 93 discreet elements including clinical decision support guidance and auto-generated, procedure-based billing codes that can be integrated into the electronic health record.

Clinical implications

As a result of this collaborative effort, a standardized report template is being built into Epic and will be openly available for pediatric urologists. Study authors believe this work will aid urodynamics interpretation for less experienced or non-urology providers through the inclusion of standardized pediatric definitions and calculation methods, while an optional risk stratification element may help improve communication across care teams.  

After the formal guidelines are implemented in Epic, the team plans to study their hypothesis that organizing elements of a urodynamics report into a standardized template with clinical decision support will result in improved interrater reliability.