Introduction: Pediatric lower urinary tract symptoms (pLUTS) is a common condition of the bladder, affecting up to 20% of children. We aim to characterize healthcare utilization for the treatment of non-neurogenic pLUTS in the United States and identify demographic and clinical factors associated with increased use to improve delivery of care to high-risk groups. Methods: Using the IBM® MarketScan® Research Databases from 2006-2016, children ages 5-18 years with pLUTS were identified using ICD9/10 codes. Patients with neurogenic bladder, kidney transplant and urological anomalies were excluded. Diagnostic tests (urinalysis, urine culture, uroflow), imaging (RBUS, KUB) used for screening, and adjunct treatments (biofeedback, anticholinergics, DDAVP) for refractory symptoms were captured using CPT and NDC codes from time of first diagnosis. Utilization was defined by percentage of patients who received a procedure, counted once. A multivariate logistic regression analysis was performed to investigate differences in utilization based on age, sex, geographic region, insurance type, and comorbid diagnoses of ADHD, autism, and/or constipation. Results: 2,651,608 unique patients with pLUTS were identified (mean [SD] age: 11.13 [4.61]), representing 1.73% of the total database. 4.50% had constipation, 1.31% had ADHD, and 0.18% had autism. Urinalysis was performed most frequently (76.1%), followed by urine culture (53.3%), RBUS (4.5%), and KUB (1.9%). Logistic regression analysis demonstrated that all predictor variables affected usage rates of all tests and procedures in the full models (Wald p<0.05). Females utilized higher rates of urinalysis (OR 1.62; 95%CI 1.61-1.63, p<0.0001) and urine culture (OR 3.15; 95%CI 3.13-3.17, p<0.0001). Children with constipation utilized higher rates of RBUS (OR 4.69; 95%CI 4.61-4.77, p<0.0001), KUB (OR 16.95; 95%CI 16.61-17.29, p<0.0001), biofeedback (OR 17.02; 95%CI 14.50-19.98, p<0.0001), and uroflow (OR 12.24; 95%CI 11.89-12.61, p<0.0001). DDAVP was used more by children with ADHD (OR 3.94; 95%CI 3.75-4.14, p<0.0001). Conclusions: Screening procedures were appropriately used more frequently. We saw a lower rate than expected of constipation, however there was continued higher utilization of procedures in this group. Patients with pLUTS and comorbid diagnoses represent a high-risk group that requires further analysis to optimize the delivery of care. SOURCE OF Funding: Funding provided by the Stanford Medical Scholars Fellowship Program.
.jpg "Abby Lynn Chen, BS (she/her/hers) photo")