Radiology, Vol 154, 607-611, Copyright © 1985 by Radiological Society of North America
Excretory urography in current practice: evidence against overutilization
P Doubilet, BJ McNeil, FX Van Houten, A Berenberg, S Ratnofsky, RA Greenes, JW Anderson, HZ Mellins and HL Abrams
Excretory urography could be performed less frequently if some combinations
of genitourinary signs and symptoms were found to be predictive of either a
specific disease or normality. To explore this possibility, the authors
conducted a prospective study involving more than 3,000 patients at three
institutions (a teaching hospital, a community hospital, and a health
maintenance organization). Predictive algorithms were obtained by
application of a polychotomous logistic regression model but did poorly at
differentiating normal from abnormal patients or arriving at a specific
diagnosis. Selection of patients on the basis of the logistic model would
have required testing 90% of all patients in order to detect 95% of those
with abnormal urograms. These results suggest that current clinical
selection criteria for excretory urography are effective, and that present
frequency of utilization is appropriate.
